Active NPI
Stanislav Mordarskiy, OD
- Optometrist
- Crest Hill, IL
National Provider Identifier
1477442747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.011978
- Practice address
- 1701 N Larkin Ave Ste 105
Crest Hill, IL 60403-3457 - Phone
- (815) 741-1140
- NPI assigned
- Jul 1, 2025
- Last updated
- Jul 1, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.011978 | IL | Primary |
Addresses
Primary practice location
1701 N Larkin Ave Ste 105
Crest Hill, IL 60403-3457
Mailing address
2545 Erie St
River Grove, IL 60171-1713
Phone (708) 714-2205
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.011978 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Priziva Optical, LTD. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751328000000",
"number": "1477442747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 ERIE ST",
"city": "RIVER GROVE",
"state": "IL",
"postal_code": "601711713",
"telephone_number": "708-714-2205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 N LARKIN AVE STE 105",
"city": "CREST HILL",
"state": "IL",
"postal_code": "604033457",
"telephone_number": "815-741-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORDARSKIY",
"first_name": "STANISLAV",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-01",
"last_updated": "2025-07-01",
"certification_date": "2025-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.011978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crest Hill, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.