NPIMap

Organization Active NPI

Southport Eye Associates LTD

Doing business as Custom Eyes

  • Optometrist
  • Chicago, IL
National Provider Identifier
1639302383
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.009541 Issued in IL
Legal business name
SOUTHPORT EYE ASSOCIATES LTD
Doing business as
Custom Eyes
Practice address
3539 N Southport Ave
Chicago, IL 60657
Phone
(773) 871-2020
Fax
(773) 871-2099
NPI assigned
Aug 28, 2009
Last updated
May 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Authorized official

Name
Dr. Michael Sculley, ODNPI 1336253889
Title
Optometrist
Phone
(773) 871-2020

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 046.009541 IL Primary

Addresses

Primary practice location

3539 N Southport Ave
Chicago, IL 60657

Mailing address

3539 N Southport Ave
Chicago, IL 60657-6447
Phone (773) 871-2020

Other names 1

  • Custom Eyes Doing business as

National Provider Directory

National Provider Directory

Locations

3539 N Southport Ave
Unit North
Chicago, IL 60657
Phone (773) 975-2015

500 W Madison St
#G11
Chicago, IL 60661

607 N State St
Chicago, IL 60654
Phone (312) 929-3720

Practitioners & affiliated clinicians

Practitioners 10

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": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1639302383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3539 N SOUTHPORT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576447",
            "telephone_number": "773-871-2020",
            "fax_number": "773-871-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3539 N SOUTHPORT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-871-2020",
            "fax_number": "773-871-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT EYE ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-28",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "SCULLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "773-871-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.009541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Eyes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.