Individual provider Active NPI

Aideen McEnaney, OD

  • Optometrist
  • O Fallon, IL
National Provider Identifier
1770343246
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046011867 Issued in IL
Practice address
2004 W Highway 50
O Fallon, IL 62269-1628
Phone
(573) 308-6208
NPI assigned
Mar 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046011867 IL Primary

Addresses

Primary practice location

2004 W Highway 50
O Fallon, IL 62269-1628

Mailing address

1477 Cantwell LN Apt 6
Swansea, IL 62226-7603
Phone (573) 308-6208

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241016002258 IL Practitioner - Optometry 2769914613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christina J. Levi O D P C.Group PAC ID 9436210762, 63 clinicians

Practice addresses (Care Compare)

2004 W Hwy 50
O Fallon, IL 62269-1628
Phone (618) 397-6575

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046011867ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Christina J. Levi O D P C Optometrist CurrentSince Aug 8, 2024 Accepting new patients
Christina J. Levi O D P C Optometrist Past Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

2100 Troy Rd
Ste 104
Edwardsville, IL 62025
Phone (618) 656-8888

2100 Troy Rd
Edwardsville, IL 62025
Phone (618) 656-8888

2004 W Highway 50
O Fallon, IL 62269
Phone (573) 308-6208

Organizations & group practices 2

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": "1710892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1770343246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 CANTWELL LN APT 6",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622267603",
            "telephone_number": "573-308-6208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 W HIGHWAY 50",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691628",
            "telephone_number": "573-308-6208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCENANEY",
        "first_name": "AIDEEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

Verify at the official NPI Registry.