Active NPI
Sandra Rafael, O.D.
- Optometrist
- Chicago, IL
National Provider Identifier
1497801757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.008419
- Practice address
- 6200 N Clark St
Chicago, IL 60660-1208 - Phone
- (773) 743-1221
- Fax
- (773) 743-1298
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 046.008419 | IL | Primary |
Addresses
Primary practice location
6200 N Clark St
Chicago, IL 60660-1208
Mailing address
6200 N Clark St
Chicago, IL 60660-1208
Phone (773) 743-1221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.008419 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Q Optique at Imd, Inc. | Optometrist | Current | Accepting new patients |
| Village Eye Care LTD | Optometrist | Past | Accepting new patients |
Locations
709 S Seeley St
Chicago, IL 60612
Phone (312) 262-5725
Interoperability endpoints
- direct@chicagoeyesltdchicagoil.compulinkdirect.com
Organizations & group practices 3
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.
-
- Optometrist
- Chicago, IL
- NPI 1477601664
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452816000000",
"number": "1497801757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6200 N CLARK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606601208",
"telephone_number": "773-743-1221",
"fax_number": "773-743-1298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 N CLARK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606601208",
"telephone_number": "773-743-1221",
"fax_number": "773-743-1298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAFAEL",
"first_name": "SANDRA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2016-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.008419",
"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 Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.