730 North Optometry PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

730 NORTH OPTOMETRY PC

Doing business as

730 north optometry

Practice address

730 N Milwaukee Ave
Libertyville, IL 60048-1914

Phone

(847) 362-9900

Fax

(847) 362-9936

NPI assigned

Jun 3, 2013

Last updated

Sep 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela C Pak Oh, ODNPI 1134567225

Title

President

Phone

(312) 282-5661

Specialties & licenses 1

Addresses

Other names 1

• 730 north optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Angela C Pak Oh, O.D.

  • Optometrist
  • Libertyville, IL
  • NPI 1134567225
  Medicare reassignment Care Compare group Authorized official
• John Ichishita, O.D.

  • Optometrist
  • Libertyville, IL
  • NPI 1164854386
  Medicare reassignment Care Compare group NPD
• Pearl H Santilukka, O.D.

  • Optometrist
  • Mundelein, IL
  • NPI 1861877300
  Medicare reassignment Care Compare group
• Diana Yin, OD

  • Optometrist
  • Lake Bluff, IL
  • NPI 1023501483
  Medicare reassignment NPD
• Laura Mangers, OD

  • Optometrist
  • Thornton, CO
  • NPI 1811093164
  NPD (past)
• Kelly Marie Daugherty Zielaskowski, O.D.

  • Optometrist
  • Rockford, MI
  • NPI 1699974154
  NPD (past)

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1821435660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481914",
            "telephone_number": "847-362-9900",
            "fax_number": "847-362-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N MILWAUKEE AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481914",
            "telephone_number": "847-362-9900",
            "fax_number": "847-362-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "730 NORTH OPTOMETRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "PAK OH",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-282-5661",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "730 north optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.