Active NPI
Irve Denenberg, OD
- Occupational Vision Optometrist
- Great Lakes, IL
National Provider Identifier
1891775144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Vision Optometrist
- License
- 2794
- Practice address
- 1020 11TH Ave
Great Lakes, IL 60088-3102 - Phone
- (847) 688-7757
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Vision Optometrist | 152WX0102X | 2794 | WI | Primary |
Addresses
Primary practice location
1020 11TH Ave
Great Lakes, IL 60088-3102
Mailing address
2074 Madison Ave
Gurnee, IL 60031-6301
Phone (847) 688-5575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2524 | CO | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1891775144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2074 MADISON AVE",
"city": "GURNEE",
"state": "IL",
"postal_code": "600316301",
"telephone_number": "847-688-5575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 11TH AVE",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600883102",
"telephone_number": "847-688-7757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENENBERG",
"first_name": "IRVE",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "WI",
"license": "2794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.