NPIMap

Organization Active NPI

Vintage Eyephoria

  • Optician
  • Chicago, IL
National Provider Identifier
1740649078
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
41564499 Issued in IL
Legal business name
VINTAGE EYEPHORIA
Practice address
4610 N Lincoln Ave
Chicago, IL 60625-2008
Phone
(773) 561-0870
NPI assigned
Feb 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2016

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

Authorized official

Name
Teodoro CarrilloNPI 1962528372
Title
Owner
Phone
(773) 561-0870

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X 41564499 IL Primary

Addresses

Primary practice location

4610 N Lincoln Ave
Chicago, IL 60625-2008

Mailing address

4610 N Lincoln Ave
Chicago, IL 60625-2008

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1740649078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252008",
            "telephone_number": "773-561-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE EYEPHORIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "TEODORO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-561-0870"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "IL",
            "license": "41564499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.