Ken Mia Vision LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

KEN MIA VISION LLC

Doing business as

Pearle Vision

Practice address

14702 Cicero Ave
Midlothian, IL 60445-3173

Phone

(708) 687-2115

NPI assigned

Oct 30, 2019

Last updated

Oct 30, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Hector Garcia

Title

President

Phone

(708) 802-1553

Specialties & licenses 1

Addresses

Other names 1

• Pearle Vision Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dayra Melissa Macias, O.D

  • Optometrist
  • Midlothian, IL
  • NPI 1679350375
  Medicare reassignment NPD
• Deborah Wagner Cope, OD

  • Optometrist
  • Maricopa, AZ
  • NPI 1821168394
  NPD (past)
• Ronald H Cope, OD

  • Optometrist
  • Maricopa, AZ
  • NPI 1265506224
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1487298774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14702 CICERO AVE",
            "city": "MIDLOTHIAN",
            "state": "IL",
            "postal_code": "604453173",
            "telephone_number": "708-687-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14702 CICERO AVE",
            "city": "MIDLOTHIAN",
            "state": "IL",
            "postal_code": "604453173",
            "telephone_number": "708-687-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN MIA VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-802-1553",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bernetta Hughey, PHARM.D.
• Dorothy M. Hunley-Adams
• Stacey A Hunt, COTA-L
• Paige Frances Ignatowicz
• Allen F. Jung, D.D.S.
• Karen Kiffmeyer, M.S. CCC-SLP
• Mark Allan Kreis
• Jessica Kryza, COTA
• Kristen N Kubicz, PHARM.D.
• Loretta Rose Kunovic, LCPC

• Optometrist in Midlothian, IL
• Providers in Midlothian, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.