Joshua L Korsgarden, O.D.
Individual provider Active NPI Optometrist · Sugar Grove, IL
NPI 1821036237 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1821036237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 047-930861 (IL)
- Practice address
- 472 N State Route 47
Suite E
Sugar Grove, IL 60554-8106 - Phone
- (630) 650-2041
- NPI assigned
- Jun 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2004
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
472 N Sugar Grove Pkwy
Sugar Grove, IL 60554-8109
Phone (630) 466-4646
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040921001052 | IL | Practitioner - Optometry | 1052389624 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047-930861 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joshua L. Korsgarden, O.D., LTD. | Optometrist | Current |
Accepting new patients |
| Adams Eyecare, PC | Optometrist | Past | Accepting new patients |
Locations
472 Route 47
Ste E
Sugar Grove, IL 60554
Phone (630) 466-4646
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 047-930861 | IL | Yes |
Addresses
Primary practice location
472 N State Route 47
Suite E
Sugar Grove, IL 60554-8106
Mailing address
139A Gillett St
Sugar Grove, IL 60554-9323
Phone (630) 650-2041
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 346-002120 | Other | IL | CS LICENSE |
| 047-930861 | Medicaid | IL |
Other providers in Sugar Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.