Individual provider Active NPI

Amie Gandhi, OD

  • Optometrist
  • Rockford, IL
National Provider Identifier
1780317453
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011637 Issued in IL
Practice address
1200 W State St FL 2
Rockford, IL 61102-2112
Phone
(815) 209-9642
Fax
(815) 918-8499
NPI assigned
Jul 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011637 IL Primary

Addresses

Primary practice location

1200 W State St FL 2
Rockford, IL 61102-2112

Mailing address

395 Polo Club Dr
Glendale Heights, IL 60139-2189
Phone (630) 767-9362

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
I20220916003215 IL Practitioner - Optometry 1052796612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2022
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)

1603 N Alpine Rd
Suite 121
Rockford, IL 61107-1439
Phone (815) 397-5959

2100 Troy Rd
Edwardsville, IL 62025-2595
Phone (618) 656-8888

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011637ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Christina J. Levi O D P C Optometrist CurrentSince Jul 1, 2022 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

134 E Blackhawk Dr
Byron, IL 61010
Phone (815) 234-2020

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

1603 N Alpine Rd
Ste 121
Rockford, IL 61107
Phone (815) 397-5959

1200 W State St
Fl 2
Rockford, IL 61102
Phone (815) 209-9642

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": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1780317453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 POLO CLUB DR",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392189",
            "telephone_number": "630-767-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST FL 2",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-209-9642",
            "fax_number": "815-918-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDHI",
        "first_name": "AMIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.