Active NPI
Advanced Eye Care SC
- Ophthalmology Physician
- New Lenox, IL
National Provider Identifier
1831154947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 036097974
- Legal business name
- ADVANCED EYE CARE SC
- Practice address
- 1870 Silver Cross Blvd
Suite 110
New Lenox, IL 60451-8639 - Phone
- (815) 485-2727
- Fax
- (815) 485-3034
- NPI assigned
- Apr 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Timothy A Kisla, DO
- Title
- Owner
- Phone
- (815) 485-2727
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 036097974 | IL | Primary |
Addresses
Primary practice location
1870 Silver Cross Blvd
Suite 110
New Lenox, IL 60451-8639
Mailing address
1870 Silver Cross Blvd
Suite 110
New Lenox, IL 60451-1871
Phone (815) 485-2727
Other practice location 1
15900 W 127th St Ste 200
Lemont, IL 60439-2912
Phone (815) 485-2727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040218000397 | IL | Part B Supplier - Clinic/Group Practice | 0446145577 |
Receives reassigned benefits from 9 practitioners Practice locations: Orland Park, IL; Olympia Fields, IL; New Lenox, IL; Mokena, IL; Lemont, IL; Homewood, IL; Hinsdale, IL; Evergreen Park, IL… |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2304747 | Advanced Eye Care, SC | Certificate of waiver | May 16, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1710806400000",
"number": "1831154947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1870 SILVER CROSS BLVD",
"address_2": "SUITE 110",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604511871",
"telephone_number": "815-485-2727",
"fax_number": "815-485-3034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1870 SILVER CROSS BLVD",
"address_2": "SUITE 110",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604518639",
"telephone_number": "815-485-2727",
"fax_number": "815-485-3034"
}
],
"practiceLocations": [
{
"address_1": "15900 W 127th St Ste 200",
"address_purpose": "LOCATION",
"city": "Lemont",
"state": "IL",
"postal_code": "604392912",
"country_code": "US",
"telephone_number": "815-485-2727",
"fax_number": "815-485-3034",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "ADVANCED EYE CARE SC",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-20",
"last_updated": "2024-03-19",
"certification_date": "2024-03-19",
"status": "A",
"authorized_official_last_name": "KISLA",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "815-485-2727",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "IL",
"license": "036097974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
- Yasmeen Mohammad Abu-Samra, CNM
- Accelerated Rehabilitation Centers, LTD
- Acura Medical Equipment & Supplies Inc
- Anese Linda Adams Collier
- Advanced Eye Care SC
- Advanced Midwest Interventional Radiology, LLC
- Advanced Midwest Radiology S C
- Advantage Speech Therapy Solutions, LLC
- Affinity Healthcare and Wellness PLLC
- Angela Agnich, CRNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.