Individual provider Active NPI

Michelle C Gianfriddo, O.D.

  • Optometrist
  • Vernon Hills, IL
National Provider Identifier
1619040888
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
46008198 Issued in IL
Practice address
503 Hawthorne Shopping Center
Vernon Hills, IL 60061-2680
Phone
(847) 816-1188
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 46008198 IL Primary

Addresses

Primary practice location

503 Hawthorne Shopping Center
Vernon Hills, IL 60061-2680

Mailing address

2015 McDaniel Ave
Evanston, IL 60201-2124
Phone (847) 869-2074

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
I20091214000620 IL Practitioner - Optometry 9537209036 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
46008198ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Luxottica of America Inc. Past Accepting new patients

Organizations & group practices 2

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619040888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 MCDANIEL AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012124",
            "telephone_number": "847-869-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 HAWTHORNE SHOPPING CENTER",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600612680",
            "telephone_number": "847-816-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIANFRIDDO",
        "first_name": "MICHELLE",
        "middle_name": "C",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46008198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon Hills, IL

Sources for this page

Verify at the official NPI Registry.