Organization Active NPI

Linas a. Sidrys M.D.

  • Ophthalmology Physician
  • Streator, IL
National Provider Identifier
1578713780
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
LINAS A. SIDRYS M.D.
Practice address
111 Westgate PLZ
Streator, IL 61364-2767
Phone
(815) 672-4018
Fax
(815) 672-5160
NPI assigned
Sep 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Linas A Sidrys, M.D.
Title
Owner
Phone
(815) 672-4018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

111 Westgate PLZ
Streator, IL 61364-2767

Mailing address

111 Westgate PLZ
Streator, IL 61364-2767
Phone (815) 672-4018

Other identifiers 1

IdentifierTypeStateIssuer
036058239MedicaidIL

National Provider Directory

National Provider Directory

Locations

111 Armory Ct
Streator, IL 61364
Phone (815) 672-4018

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1578713780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WESTGATE PLZ",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642767",
            "telephone_number": "815-672-4018",
            "fax_number": "815-672-5160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WESTGATE PLZ",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642767",
            "telephone_number": "815-672-4018",
            "fax_number": "815-672-5160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINAS A. SIDRYS M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-24",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "SIDRYS",
        "authorized_official_first_name": "LINAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-672-4018",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036058239",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Streator, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.