Organization Active NPI

Northwest Optometric Associates, LTD

  • Optometrist
  • Harwood Heights, IL
National Provider Identifier
1609908920
Registry record updated Jan 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046008854 Issued in IL
Legal business name
NORTHWEST OPTOMETRIC ASSOCIATES, LTD
Practice address
4970 N Harlem Ave
Harwood Heights, IL 60706-3552
Phone
(708) 867-7838
Fax
(708) 867-5869
NPI assigned
Mar 12, 2007
Last updated
Jan 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2008

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

Authorized official

Name
Dr. Denice Ann Rice-Kelly, O.D.NPI 1578761979
Title
Owner
Phone
(708) 867-7838

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046008854 IL Primary

Addresses

Primary practice location

4970 N Harlem Ave
Harwood Heights, IL 60706-3552

Mailing address

4970 N Harlem Ave
Harwood Heights, IL 60706-3552
Phone (708) 867-7838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120518000260 IL Part B Supplier - Clinic/Group Practice 5193988723 Receives reassigned benefits from 3 practitioners
Practice locations: Harwood Heights, IL

National Provider Directory

National Provider Directory

Locations

4970 N Harlem Ave
Harwood Hts, IL 60706
Phone (708) 867-7838

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199404800000",
    "number": "1609908920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4970 N HARLEM AVE",
            "city": "HARWOOD HEIGHTS",
            "state": "IL",
            "postal_code": "607063552",
            "telephone_number": "708-867-7838",
            "fax_number": "708-867-5869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4970 N HARLEM AVE",
            "city": "HARWOOD HEIGHTS",
            "state": "IL",
            "postal_code": "607063552",
            "telephone_number": "708-867-7838",
            "fax_number": "708-867-5869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST OPTOMETRIC ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2008-01-04",
        "status": "A",
        "authorized_official_last_name": "RICE-KELLY",
        "authorized_official_first_name": "DENICE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-867-7838",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harwood Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.