Active NPI
Matthew Daniel Pietruszka, OD
- Optometrist
- Chicago, IL
National Provider Identifier
1679001101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046011095
- Practice address
- 555 S Dearborn St
Chicago, IL 60605-1586 - Phone
- (312) 614-2020
- Fax
- (312) 626-5139
- NPI assigned
- May 29, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 046011095 | IL | Primary |
Addresses
Primary practice location
555 S Dearborn St
Chicago, IL 60605-1586
Mailing address
5438 S 74TH Ave
Summit, IL 60501-1013
Phone (312) 614-2020
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170615002571 | IL | Practitioner - Optometry | 2961770979 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046011095 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543795200000",
"number": "1679001101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5438 S 74TH AVE",
"city": "SUMMIT",
"state": "IL",
"postal_code": "605011013",
"telephone_number": "312-614-2020",
"fax_number": "312-626-5139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 S DEARBORN ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606051586",
"telephone_number": "312-614-2020",
"fax_number": "312-626-5139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIETRUSZKA",
"first_name": "MATTHEW",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-29",
"last_updated": "2018-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046011095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.