NPIMap

Organization Active NPI

Eye Boutique, LLC

  • Optometrist
  • Crystal Lake, IL
National Provider Identifier
1679721591
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE BOUTIQUE, LLC
Practice address
5005 Northwest Hwy
Crystal Lake, IL 60014-7330
Phone
(815) 479-0177
Fax
(262) 923-7673
NPI assigned
Sep 4, 2008
Last updated
Mar 2, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
LUXOTTICA OF AMERICA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Authorized official

Name
Mr. Darren Thomas Horndasch
Title
President
Phone
(262) 432-2005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

5005 Northwest Hwy
Crystal Lake, IL 60014-7330

Mailing address

16800 W Cleveland Ave
New Berlin, WI 53151-3533
Phone (262) 432-2005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090304000089 IL Part B Supplier - Clinic/Group Practice 7012073851 Receives reassigned benefits from 6 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Schaumburg, IL; Naperville, IL; Joliet, IL; Geneva, IL; Crystal Lake, IL; Algonquin, IL
O20100930031949 IL DME Supplier - Physician - Optometrist 7012073851 Practice locations: Crystal Lake, IL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Luxottica Retail North Amer

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5005 N West Hwy
Crystal Lake, IL 60014
Phone (815) 479-0177

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1679721591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16800 W CLEVELAND AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531513533",
            "telephone_number": "262-432-2005",
            "fax_number": "262-432-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147330",
            "telephone_number": "815-479-0177",
            "fax_number": "262-923-7673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE BOUTIQUE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUXOTTICA OF AMERICA INC",
        "enumeration_date": "2008-09-04",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "HORNDASCH",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-432-2005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.