Active NPI
Michael Joseph Fary, O.D.
- Optometrist
- Burbank, IL
National Provider Identifier
1629344247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.010408
- Practice address
- 7708 S Cicero Ave
Suite A5
Burbank, IL 60459 - Phone
- (708) 346-0624
- NPI assigned
- Mar 28, 2012
- Sex
- Male
- 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 | 046.010408 | IL | Primary |
Addresses
Primary practice location
7708 S Cicero Ave
Suite A5
Burbank, IL 60459
Mailing address
7708 S. Cicero Avenue
Suite A5
Burbank, IL 60459
Phone (708) 346-0624
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.010408 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1629344247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7708 S. CICERO AVENUE",
"address_2": "SUITE A5",
"city": "BURBANK",
"state": "IL",
"postal_code": "60459",
"telephone_number": "708-346-0624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7708 S CICERO AVE",
"address_2": "SUITE A5",
"city": "BURBANK",
"state": "IL",
"postal_code": "60459",
"telephone_number": "708-346-0624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARY",
"first_name": "MICHAEL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-28",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.010408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.