Glenn D. Kueltzo, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

Practice address

13231 W 143Rd St
Suite 101
Homer Glen, IL 60491-6638

Phone

(708) 301-2020

Fax

(708) 301-0884

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interstate Optical LBR IncGroup PAC ID 8628165750, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Interstate Optical LBR Inc

  • Optician
  • Mokena, IL
  • NPI 1114965126
  Medicare reassignment Care Compare group NPD
• Rosin Optical Co., Inc

  • Optometrist
  • Berwyn, IL
  • NPI 1235343641
  Medicare reassignment NPD
• Rosin Optical Co. Inc.

  • Optometrist
  • Skokie, IL
  • NPI 1750945408
  NPD
• Rosin Optical Co. Inc.

  • Optometrist
  • Orland Park, IL
  • NPI 1811413198
  NPD
• Albina Optometric

  • Optometrist
  • Burbank, IL
  • NPI 1619475852
  NPD (past)
• Comprehensive Eyecare Physicians PC

  • Ophthalmology Physician
  • Berwyn, IL
  • NPI 1205959053
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188518400000",
    "number": "1740290386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13231 W 143RD ST",
            "address_2": "SUITE 101",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916638",
            "telephone_number": "708-301-2020",
            "fax_number": "708-301-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13231 W 143RD ST",
            "address_2": "SUITE 101",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916638",
            "telephone_number": "708-301-2020",
            "fax_number": "708-301-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUELTZO",
        "first_name": "GLENN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "0039940592",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Kolpak, LPC, NCC
• Michelle Rose Krepps, MSW LCSW
• Patricia C Krouse, RPH
• Michelle Albina Krupa, RN
• Biljana Krzywinski, LCPC
• Kwikrx LLC
• Kwikrx LLC
• La Rabida Children'S Hospital
• Iwona Laciak, P.T.
• Dale Arthur Laning, D.P.M.

• Optometrist in Homer Glen, IL
• Providers in Homer Glen, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2007; 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.