Individual provider Active NPI

Junmo Kwon, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1780569194
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011989 Issued in IL
Practice address
1101 S Canal St Ste 108
Chicago, IL 60607-4940
Phone
(312) 588-0159
NPI assigned
Aug 6, 2025
Last updated
Aug 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011989 IL Primary

Addresses

Primary practice location

1101 S Canal St Ste 108
Chicago, IL 60607-4940

Mailing address

2901 S Michigan Ave Apt 2008
Chicago, IL 60616-3462
Phone (312) 216-7142

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
I20250829002356 IL Practitioner - Optometry 8628579711 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

19100 Ridgewood Pkwy
San Antonio, TX 78259-1828

19100 Ridgewood Pkwy
BLDG 1 7TH Floor
San Antonio, TX 78259-0001

2901 S Michigan Ave
Apt 2008
Chicago, IL 60616-3250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011989ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Visionworks, Inc CurrentSince Aug 25, 2025 Accepting new patients
Visionworks, Inc. Optometrist CurrentSince Aug 25, 2025 Accepting new patients

Locations

1101 S Canal St
Ste 108
Chicago, IL 60607
Phone (312) 558-0159

239 Golf Mill Ctr
Ste 255
Niles, IL 60714
Phone (847) 297-2286

2422 US Highway 34
Oswego, IL 60543
Phone (630) 551-4133

19100 Ridgewood Pkwy
Bldg 1
San Antonio, TX 78259
Phone (726) 444-4069

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1754438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1780569194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 S MICHIGAN AVE APT 2008",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163462",
            "telephone_number": "312-216-7142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S CANAL ST STE 108",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074940",
            "telephone_number": "312-588-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "JUNMO",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-06",
        "last_updated": "2025-08-06",
        "certification_date": "2025-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.