Active NPI
Beverly Jane Lezondra, O.D.
- Optometrist
- Bolingbrook, IL
National Provider Identifier
1740470830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Practice address
- 641 E Boughton Rd
Suite 105
Bolingbrook, IL 60440-3143 - Phone
- (630) 783-0138
- NPI assigned
- Jul 26, 2007
- Sex
- Female
- 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 | IL | Primary |
Addresses
Primary practice location
641 E Boughton Rd
Suite 105
Bolingbrook, IL 60440-3143
Mailing address
15919 Selfridge Cir
Plainfield, IL 60586-7211
Phone (708) 359-5336
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046009966 | IL | MD | Optometrist |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1740470830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15919 SELFRIDGE CIR",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605867211",
"telephone_number": "708-359-5336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "641 E BOUGHTON RD",
"address_2": "SUITE 105",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604403143",
"telephone_number": "630-783-0138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEZONDRA",
"first_name": "BEVERLY",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-26",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.