Individual provider Active NPI

Bethany E. Ward, O.D.

  • Optometrist
  • Chicago, IL
National Provider Identifier
1578791778
Registry record updated May 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.010246 Issued in IL
Practice address
1401 E 87TH St
Chicago, IL 60619-6522
Phone
(773) 721-8787
Fax
(773) 721-5674
NPI assigned
Jun 25, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.010246 IL Primary

Addresses

Primary practice location

1401 E 87TH St
Chicago, IL 60619-6522

Mailing address

1401 E 87TH St
Chicago, IL 60619-6522
Phone (773) 721-8787

Other identifiers 2

IdentifierTypeStateIssuer
97418002MedicaidIL
579270056OtherILMEDICARE

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090922000688 IL Practitioner - Optometry 2860548591 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Le Vision IncGroup PAC ID 0244370658, 5 clinicians

Practice addresses (Care Compare)

4466 N Broadway
Chicago, IL 60640-5660
Phone (773) 561-4510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.010246ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Illinois, LLC Optometrist CurrentSince Jul 22, 2024 Accepting new patients
Myeyedr Optometry of Illinois, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Illinois, LLC Optometrist CurrentSince Jul 22, 2024 Accepting new patients
Le Vision Inc. Optometrist CurrentSince Jun 11, 2020 Accepting new patients
Eyecare Associates Limited Optometrist Past Accepting new patients
Myeyedr Optometry of Illinois, LLC Optometrist Past Accepting new patients

Locations

5408 N Clark St
Chicago, IL 60640
Phone (773) 275-2020

4466 N Broadway St
Chicago, IL 60640
Phone (773) 561-4510

1652 Beecher Rd
Yorkville, IL 60560
Phone (630) 385-3201

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 6

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274659200000",
    "number": "1578791778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E 87TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196522",
            "telephone_number": "773-721-8787",
            "fax_number": "773-721-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E 87TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196522",
            "telephone_number": "773-721-8787",
            "fax_number": "773-721-5674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARD",
        "first_name": "BETHANY",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2010-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.010246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97418002",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "579270056",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.