NPIMap

Organization Active NPI

Weltzer-Maite, P.C.

Doing business as Pearle Vision

  • Optometrist
  • Chicago, IL
National Provider Identifier
1780615955
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
060-0007483 Issued in IL
Legal business name
WELTZER-MAITE, P.C.
Doing business as
Pearle Vision
Practice address
400 W Division St
Chicago, IL 60610-1727
Phone
(312) 274-1212
Fax
(773) 327-3015
NPI assigned
Jul 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Spencer Paul Vidulich, O.D.NPI 1184655441
Title
Owner
Phone
(773) 327-3000

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: 193200000X MULTI-SPECIALTY GROUP 152W00000X 060-0007483 IL Primary

Addresses

Primary practice location

400 W Division St
Chicago, IL 60610-1727

Mailing address

400 W Division St
Chicago, IL 60610-1727
Phone (312) 274-1212

Other names 1

  • Pearle Vision Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080929000096 IL Part B Supplier - Clinic/Group Practice 3577630805 Receives reassigned benefits from 7 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

400 W Division St
Chicago, IL 60610
Phone (312) 274-1212

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780615955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W DIVISION ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606101727",
            "telephone_number": "312-274-1212",
            "fax_number": "773-327-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W DIVISION ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606101727",
            "telephone_number": "312-274-1212",
            "fax_number": "773-327-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELTZER-MAITE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VIDULICH",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-327-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "060-0007483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.