Active NPI
Angelica Cardenas
- Optometrist
- Chicago, IL
National Provider Identifier
1548993389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.011636
- Practice address
- 4466 N Broadway St
Chicago, IL 60640-5660 - Phone
- (773) 728-0966
- Fax
- (773) 506-3843
- NPI assigned
- Jul 8, 2022
- Sex
- Female
- 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 | 046.011636 | IL | Primary |
Addresses
Primary practice location
4466 N Broadway St
Chicago, IL 60640-5660
Mailing address
4300 N Marine Dr Apt 1606
Chicago, IL 60613-5808
Phone (619) 857-3221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10 Woodbridge Ctr Dr
Suite 425
Woodbridge, NJ 07095-1170
2421 W Beverly Blvd
Montebello, CA 90640-2305
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.011636 | IL | MD | Optometrist |
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": "1657238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657238400000",
"number": "1548993389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 N MARINE DR APT 1606",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606135808",
"telephone_number": "619-857-3221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4466 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405660",
"telephone_number": "773-728-0966",
"fax_number": "773-506-3843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARDENAS",
"first_name": "ANGELICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-08",
"last_updated": "2022-07-08",
"certification_date": "2022-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.011636",
"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 Jul 8, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.