Lumen Optical Illinois 1, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

LUMEN OPTICAL ILLINOIS 1, LLC

Practice address

20505 Rand Rd
Kildeer, IL 60047-3004

Phone

(801) 792-0477

NPI assigned

Dec 18, 2015

Last updated

Jan 21, 2016By 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

Heather Allen

Title

Privacy Officer

Phone

(801) 316-5508

Specialties & licenses 11

Addresses

Locations

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1497110332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20505 RAND RD",
            "address_2": "SUITE 500",
            "city": "KILDEER",
            "state": "IL",
            "postal_code": "600473004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20505 RAND RD",
            "city": "KILDEER",
            "state": "IL",
            "postal_code": "600473004",
            "telephone_number": "801-792-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMEN OPTICAL ILLINOIS 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-18",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PRIVACY OFFICER",
        "authorized_official_telephone_number": "801-316-5508"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156F00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Contact Lens",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.