Individual provider Active NPI

Sameena Naz Razvi, O.D.

  • Optometrist
  • Gurnee, IL
National Provider Identifier
1780634980
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
46010019 Issued in IL
Practice address
6641 Grand Ave Ste D
Gurnee, IL 60031-5262
Phone
(847) 856-1200
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 46010019 IL Primary

Addresses

Primary practice location

6641 Grand Ave Ste D
Gurnee, IL 60031-5262

Mailing address

5527 35TH St Unit 102
Kenosha, WI 53144-4807
Phone (802) 999-1028

Other identifiers 1

IdentifierTypeStateIssuer
1012551MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
46010019ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael Taub OD PC Optometrist Past Accepting new patients
Juli a Larson PC Vermont Eye Associates PastSince Jul 1, 1993 Accepting new patients
Vermont Family Eye Care, Inc. Optometrist Past Accepting new patients
Juli a. Larson MD PLLC Past Accepting new patients

Organizations & group practices 4

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1780634980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5527 35TH ST UNIT 102",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531444807",
            "telephone_number": "802-999-1028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6641 GRAND AVE STE D",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315262",
            "telephone_number": "847-856-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZVI",
        "first_name": "SAMEENA",
        "middle_name": "NAZ",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46010019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012551",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.