Wanderlust Eyecare, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010799 Issued in IL

Legal business name

WANDERLUST EYECARE, P.C.

Practice address

1745 Orchard LN
Northfield, IL 60093-3432

Phone

(847) 787-1187

Fax

(847) 789-7181

NPI assigned

May 9, 2018

Last updated

Jul 17, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Faye Therese P. Gamboa, ODNPI 1275948044

Title

President/Owner

Phone

(847) 787-1187

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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.

• Faye Therese Gamboa, O.D.

  • Optometrist
  • Northfield, IL
  • NPI 1275948044
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1760971220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 ORCHARD LN",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933432",
            "telephone_number": "847-787-1187",
            "fax_number": "847-789-7181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 ORCHARD LN",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933432",
            "telephone_number": "847-787-1187",
            "fax_number": "847-789-7181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDERLUST EYECARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-09",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "GAMBOA",
        "authorized_official_first_name": "FAYE THERESE",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "847-787-1187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1275948044",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven H Vogelstein, M.A., L.C.S.W.
• Abby Vogler
• Sasha P Von Varga, L.C.S.W.
• Walgreen Co (Walgreens #03926)
• David Moulton Walton, PH.D.
• James Parker Ward, LCSW
• Meleta Jacobs Ward, LIC CLIN SOC WORKER
• Warner Aesthetic & Reconstructive Institute
• Jeremy Patrick Warner, M.D.
• Antonia Warren, LCSW

• Optometrist in Northfield, IL
• Providers in Northfield, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.