Charles S Kefalas, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008568 Issued in IL

Practice address

4256 W 63Rd St
Chicago, IL 60629-5037

Phone

(773) 582-0660

Fax

(773) 582-0859

NPI assigned

Nov 6, 2006

Last updated

Jul 9, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1992

Medicare assignment

May accept Medicare assignment

Group practices

Charles S Kefalas OdpcGroup PAC ID 6305853607, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Charles S Kefalas Odpc

  • Optometrist
  • Chicago, IL
  • NPI 1932288198
  Medicare reassignment Care Compare group NPD Authorized official
• Bridgeport Eye Care, LLC

  dba Miami Optical

  • Optometrist
  • Chicago, IL
  • NPI 1144711243
  NPD (past)
• Southwest Optometric Associates P C

  dba Miami Optical

  • Optometrist
  • Chicago, IL
  • NPI 1699785675
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1780753939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4256 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606295037",
            "telephone_number": "773-582-0660",
            "fax_number": "773-582-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4256 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606295037",
            "telephone_number": "773-582-0660",
            "fax_number": "773-582-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEFALAS",
        "first_name": "CHARLES",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008568",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RETIRED RAILROAD MEDICARE",
            "identifier": "L83487",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Campbell Keesey, DMD
• Stephanie Keeshin, LPC
• Adina Bayuk Keesom, PSY.D.
• Sheridan Keeter, NP
• James Keeton
• Carolyn Keffer, DNP, FNP-BC
• Daniel L Kegan, PHD, JD
• Natalie Corrine Kegg
• Lindsey Kehlenbrink, OTR/L
• Kehoe & Djordjevic S.C.

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.