Active NPI
Mary Fazelian, O.D.
- Optometrist
- Chicago, IL
National Provider Identifier
1801914007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046009825
- Practice address
- 7305 W Irving Park Rd
Chicago, IL 60634-3547 - Phone
- (847) 722-8319
- NPI assigned
- Mar 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Vision Optometrist | 152WX0102X | 3190 AT | OR | |
| Optometrist | 152W00000X | 046009825 | IL | Primary |
Addresses
Primary practice location
7305 W Irving Park Rd
Chicago, IL 60634-3547
Mailing address
5710 Lee St
Morton Grove, IL 60053-3117
Phone (847) 722-8319
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046009825 | IL | MD | Optometrist |
| 3190 AT | OR | MD | Occupational Vision Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337644800000",
"number": "1801914007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5710 LEE ST",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600533117",
"telephone_number": "847-722-8319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7305 W IRVING PARK RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606343547",
"telephone_number": "847-722-8319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZELIAN",
"first_name": "MARY",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2012-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "OR",
"license": "3190 AT",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046009825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.