Active NPI
Lucas Derango, O.D.
- Optometrist
- Chicago, IL
National Provider Identifier
1487806923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.010165
- Practice address
- 2906 N Broadway St
Chicago, IL 60657-7163 - Phone
- (773) 525-1601
- NPI assigned
- Oct 15, 2008
- 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 | 046.010165 | IL | Primary |
Addresses
Primary practice location
2906 N Broadway St
Chicago, IL 60657-7163
Mailing address
2906 N Broadway St
Chicago, IL 60657-7163
Phone (773) 525-1601
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 |
|---|---|---|---|
| 046.010165 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jack Shaw Superior Eye Care | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439856000000",
"number": "1487806923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2906 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606577163",
"telephone_number": "773-525-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2906 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606577163",
"telephone_number": "773-525-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERANGO",
"first_name": "LUCAS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-15",
"last_updated": "2015-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.010165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.