Albert Simon Licup, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.009863 Issued in IL

Practice address

603 Madison St
Oak Park, IL 60302-4437

Phone

(708) 383-2150

Fax

(708) 383-2253

NPI assigned

Jul 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Zeifert Eye Care LTDGroup PAC ID 1456650092, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Zeifert Eye Care, LTD

  • Optometrist
  • Highland Park, IL
  • NPI 1437513041
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243468800000",
    "number": "1720011125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024437",
            "telephone_number": "708-383-2150",
            "fax_number": "708-383-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024437",
            "telephone_number": "708-383-2150",
            "fax_number": "708-383-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICUP",
        "first_name": "ALBERT",
        "middle_name": "SIMON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2009-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.009863",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3056-035",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle J Lewis, CHTP, RM
• Taniza Devon Lewis
• Shannon Xiang Li, MD
• Zhihong Li, O. M. D.
• Jay Anthony Liboon, D.O.
• Caitlin Liddle, LCSW
• Sophie Lieberman
• Margaret Bracco Liebreich, P.T.
• Lifespan Counseling and Psychological Services, LLP
• Lifestance Health Group Inc.

• Optometrist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; 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.

Verify at the official NPI Registry.