Active NPI
Kevin Blackett, OD
- Optometrist
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.011746
- Practice address
- 1730 W Fullerton Ave
Chicago, IL 60614-1900 - Phone
- (773) 327-3000
- NPI assigned
- Aug 11, 2023
- Last updated
- Aug 11, 2023
- 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 | 046.011746 | IL | Primary |
Addresses
Primary practice location
1730 W Fullerton Ave
Chicago, IL 60614-1900
Mailing address
1730 W Fullerton Ave
Chicago, IL 60614-1900
Phone (773) 327-3000
Other practice location 1
400 W Division St
Chicago, IL 60610-2981
Phone (312) 274-1212
Other practice location 2
904 W North Ave
Melrose Park, IL 60160-1520
Phone (708) 343-9009
Other practice location 3
4017 N Milwaukee Ave
Chicago, IL 60641-1834
Phone (773) 545-2660
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
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1730 W Fullerton Ave
Chicago, IL 60614-1900
Phone (773) 327-3000
400 W Division St
Chicago, IL 60610-2981
Phone (312) 274-1212
4017 N Milwaukee Ave
Chicago, IL 60641-1834
Phone (773) 545-2660
904 W N Ave
Melrose Park, IL 60160-1520
Phone (708) 343-9009
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.011746 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Melrose Park Eye Care LLC | Optometrist | Current | Accepting new patients |
| Riverpoint Eye Care LLC | Optometrist | Current | Accepting new patients |
| Vidulich, Blase & Valentino, P.C. | Optometrist | Current | Accepting new patients |
| Six Corners Eye Care LLC | Optometrist | Current | Accepting new patients |
| Weltzer-Maite, P.C. | Optometrist | Current | Accepting new patients |
| Thaddeus, LTD | Optometrist | Current | Accepting new patients |
| Wilma, LTD | Optometrist | Current | Accepting new patients |
| Old Town Eye Care LLC | Optometrist | Current | Accepting new patients |
Locations
1730 W Fullerton Ave
Chicago, IL 60614
Phone (773) 327-3000
400 W Division St
Chicago, IL 60610
Phone (312) 274-1212
4017 N Milwaukee Ave
Chicago, IL 60641
Phone (773) 545-2660
904 W North Ave
Melrose Park, IL 60160
Phone (708) 343-6767
Organizations & group practices 8
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Pearle Vision Melrose Park
- Optometrist
- Melrose Park, IL
- NPI 1073334595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1679256978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1730 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606141900",
"telephone_number": "773-327-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1730 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606141900",
"telephone_number": "773-327-3000"
}
],
"practiceLocations": [
{
"address_1": "400 W Division St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606102981",
"country_code": "US",
"telephone_number": "312-274-1212",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "904 W North Ave",
"address_purpose": "LOCATION",
"city": "Melrose Park",
"state": "IL",
"postal_code": "601601520",
"country_code": "US",
"telephone_number": "708-343-9009",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4017 N Milwaukee Ave",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606411834",
"country_code": "US",
"telephone_number": "773-545-2660",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACKETT",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-11",
"last_updated": "2023-08-11",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.011746",
"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 Aug 11, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.