NPIMap

Organization Active NPI

For Eyes Optical of PA

  • Optometrist
  • Broadview, IL
National Provider Identifier
1861966848
Registry record updated Jan 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FOR EYES OPTICAL OF PA
Practice address
122 Broadview Village SQ
Broadview, IL 60155-4874
Phone
(708) 343-2020
NPI assigned
Jan 14, 2019
Last updated
Jan 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2019

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

Authorized official

Name
Jose Costa
Title
Ceo
Phone
(305) 557-9004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

122 Broadview Village SQ
Broadview, IL 60155-4874

Mailing address

3601 SW 160TH Ave Ste 400
Miramar, FL 33027-6312
Phone (305) 557-9004

National Provider Directory

National Provider Directory
Tax ID family
For Eyes Optical of PA49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

Locations

122 Broadview Village Sq
Broadview, IL 60155
Phone (708) 343-2020

NPI Registry JSON

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1861966848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 SW 160TH AVE STE 400",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330276312",
            "telephone_number": "305-557-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 BROADVIEW VILLAGE SQ",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601554874",
            "telephone_number": "708-343-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOR EYES OPTICAL OF PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-557-9004"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broadview, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.