Moda Eyecare LLC
Organization Active NPI Optometrist · Clarendon Hills, IL
NPI 1831613876 · NPPES record last updated Sep 12, 2018
Key facts
- NPI
- 1831613876
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 46.010151 (IL)
- Legal business name
- MODA EYECARE LLC
- Practice address
- 225 Park Avenue
Clarendon Hills, IL 60514-1301 - Phone
- (630) 323-3202
- NPI assigned
- Aug 1, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Mirjana McCarthy, OD
- Title
- Optometrist/Owner
- Phone
- (630) 323-3202
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180125001152 | IL | Part B Supplier - Clinic/Group Practice | 5496014110 |
Receives reassigned benefits from 1 practitioner Practice locations: Clarendon Hills, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 46.010151 | IL | Yes |
Addresses
Primary practice location
225 Park Avenue
Clarendon Hills, IL 60514-1301
Mailing address
225 Park Avenue
Clarendon Hills, IL 60514-1301
Other names
- Moda Eyecare
Other providers in Clarendon Hills, IL
- Robert Alan McNutt
- Meridian & Myrrh Acupuncture and Wellness, PLLC
- Bethany Micaletti
- John Micaletti
- Brooke Middendorf
- Lauren Kate Molinaro
- Dawn Marie Nader
- Richard Nahlik
- Rochelle Antionette Nellums
- Jessica Neumann
All providers in Clarendon Hills, IL · Optometrist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.