Organization Active NPI

Katherine M Narbone OD & Joanna M Luty OD PC

  • Optometrist
  • Palos Heights, IL
National Provider Identifier
1770146045
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KATHERINE M NARBONE OD & JOANNA M LUTY OD PC
Practice address
12131 S Harlem Ave
Palos Heights, IL 60463-1492
Phone
(773) 491-7617
NPI assigned
Apr 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Joanna Maria Luty, ODNPI 1386965820
Title
Optometrist
Phone
(773) 550-2020

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

12131 S Harlem Ave
Palos Heights, IL 60463-1492

Mailing address

12131 S Harlem Ave
Palos Heights, IL 60463-1492
Phone (708) 550-2020

Other identifiers 1

IdentifierTypeStateIssuer
1386965820MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL premierfamilyvisioncare@gmail.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191115001162 IL Part B Supplier - Clinic/Group Practice 8123450970 Receives reassigned benefits from 2 practitioners
Practice locations: Palos Heights, IL

National Provider Directory

National Provider Directory

Locations

12131 S Harlem Ave
Palos Heights, IL 60463
Phone (708) 550-2020

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1770146045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12131 S HARLEM AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631492",
            "telephone_number": "708-550-2020",
            "fax_number": "708-505-8583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12131 S HARLEM AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631492",
            "telephone_number": "773-491-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHERINE M NARBONE OD & JOANNA M LUTY OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-22",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "LUTY",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "773-550-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386965820",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "premierfamilyvisioncare@gmail.com",
            "affiliation": "N",
            "address_1": "12131 S Harlem Ave",
            "city": "Palos Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604631492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.