NPIMap

Organization Active NPI

Eyes on the Lake, PC

  • Optometrist
  • Kenilworth, IL
National Provider Identifier
1689780645
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046-08599 Issued in IL
Legal business name
EYES ON THE LAKE, PC
Practice address
420 Green Bay Rd
Kenilworth, IL 60043-1075
Phone
(847) 853-1111
NPI assigned
Aug 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William R Najem, O.D.NPI 1053480038
Title
Vice President
Phone
(847) 853-1111

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046-09022 IL
Optometrist 152W00000X 046-08599 IL Primary

Addresses

Primary practice location

420 Green Bay Rd
Kenilworth, IL 60043-1075

Mailing address

420 Green Bay Rd.
Kenilworth, IL 60043-1075
Phone (847) 853-1111

National Provider Directory

National Provider Directory

Locations

420 Green Bay Rd
Kenilworth, IL 60043
Phone (847) 853-1111

Practitioners & affiliated clinicians

Practitioners 3

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": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689780645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 GREEN BAY RD.",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431075",
            "telephone_number": "847-853-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431075",
            "telephone_number": "847-853-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYES ON THE LAKE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NAJEM",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "847-853-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-09022",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-08599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenilworth, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.