Organization Active NPI

Multack Eye Care, S.C

  • Ophthalmology Physician
  • Olympia Fields, IL
National Provider Identifier
1851655989
Registry record updated Jul 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MULTACK EYE CARE, S.C
Practice address
20303 Crawford Ave
Suite LL1
Olympia Fields, IL 60461-1073
Phone
(708) 955-9278
Fax
(708) 898-1860
NPI assigned
Jul 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2012

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

Authorized official

Name
Dr. Sam Multack, D.O
Title
President
Phone
(708) 955-9278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

20303 Crawford Ave
Suite LL1
Olympia Fields, IL 60461-1073

Mailing address

20303 Crawford Ave
Suite LL1
Olympia Fields, IL 60461-1073
Phone (708) 955-9278

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120925000794 IL Part B Supplier - Clinic/Group Practice 6507015138 Receives reassigned benefits from 12 practitioners
Practice locations: Frankfort, IL; Olympia Fields, IL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2074677Multack Eye Care S C20303 S Crawford Ave, Ste L L 1, Olympia Fields, IL 60461Certificate of waiverMar 12, 2028

National Provider Directory

National Provider Directory

Locations

20303 Crawford Ave
Ste LL1
Olympia Flds, IL 60461
Phone (708) 898-1858

Interoperability endpoints

  • Direct secure messaging: ksangal@mecvision.intellechartdirect.net
  • Direct secure messaging: jgilbertson@mecvision.intellechartdirect.net
  • Direct secure messaging: jjankiewicz@mecvision.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1341360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341360000000",
    "number": "1851655989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "address_2": "SUITE LL1",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-955-9278",
            "fax_number": "708-898-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "address_2": "SUITE LL1",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-955-9278",
            "fax_number": "708-898-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTACK EYE CARE, S.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-04",
        "last_updated": "2012-07-04",
        "status": "A",
        "authorized_official_last_name": "MULTACK",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-955-9278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2012; 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.