NPIMap

Organization Active NPI

Wilma, LTD

Doing business as Pearle Vision Express

  • Optometrist
  • Melrose Park, IL
National Provider Identifier
1831120088
Registry record updated Dec 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
060-005866 Issued in IL
Legal business name
WILMA, LTD
Doing business as
Pearle Vision Express
Practice address
904 W North Ave
Melrose Park, IL 60160-1520
Phone
(708) 343-9009
Fax
(708) 343-9012
NPI assigned
Jul 6, 2006
Last updated
Dec 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2008

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

Authorized official

Name
Dr. Spencer Paul Vidulich, O.D.NPI 1184655441
Title
Owner/Doctor
Phone
(773) 327-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 060005866 IL
Optometrist 152W00000X 060-005866 IL Primary

Addresses

Primary practice location

904 W North Ave
Melrose Park, IL 60160-1520

Mailing address

904 W North Ave
Melrose Park, IL 60160-1520
Phone (708) 343-9009

Other names 1

  • Pearle Vision Express Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040920000257 IL Part B Supplier - Clinic/Group Practice 7113995036 Receives reassigned benefits from 10 practitioners
Practice locations: Melrose Park, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229558400000",
    "number": "1831120088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601520",
            "telephone_number": "708-343-9009",
            "fax_number": "708-343-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 W NORTH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601601520",
            "telephone_number": "708-343-9009",
            "fax_number": "708-343-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMA, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2008-12-18",
        "status": "A",
        "authorized_official_last_name": "VIDULICH",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "773-327-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "IL",
            "license": "060005866",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "060-005866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision Express",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.