Premium Eyecare, LTD.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010489 Issued in IL

Legal business name

PREMIUM EYECARE, LTD.

Practice address

215 W 23Rd St
Chicago, IL 60616-1903

Phone

(312) 225-3188

Fax

(312) 225-9188

NPI assigned

Sep 20, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jirasan Sakulsom, OD

Title

President

Phone

(636) 675-9167

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1508292665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 S INDIANA AVE",
            "address_2": "APT 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 23RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161903",
            "telephone_number": "312-225-3188",
            "fax_number": "312-225-9188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM EYECARE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "SAKULSOM",
        "authorized_official_first_name": "JIRASAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-675-9167",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of Illinois Medical PC
• Premise Health of Illinois Medical PC
• Premise Health of Illinois Medical PC
• Premise Health of Illinois Medical PC
• Premise Health of Illinois Medical, PC
• Tatiana Prendella, LSW
• Prendergast Pediatrics P.C.
• Erica Prendergast
• Francis M. Prendergast, MD
• Heather M Prendergast

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; 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.