Individual provider Active NPI

Marlin Khouri, O.D.

  • Optometrist
  • Joliet, IL
National Provider Identifier
1891843652
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Practice address
3340 Mall Loop Dr
1532 36 Louis Joliet Mall
Joliet, IL 60431-1057
Phone
(815) 436-1770
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X IL Primary

Addresses

Primary practice location

3340 Mall Loop Dr
1532 36 Louis Joliet Mall
Joliet, IL 60431-1057

Mailing address

3340 Mall Loop Dr
Joliet, IL 60431-1057
Phone (815) 436-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241016004416 IL Practitioner - Optometry 3274065172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christina J. Levi O D P C.Group PAC ID 9436210762, 63 clinicians

Practice addresses (Care Compare)

1192 Walter St
Suite a
Lemont, IL 60439-2905
Phone (630) 243-2020

2100 Troy Rd
Edwardsville, IL 62025-2595
Phone (618) 656-8888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046-009278ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Christina J. Levi O D P C Optometrist CurrentSince Sep 15, 2024 Accepting new patients
Christina J. Levi O D P C Optometrist Past Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

2100 Troy Rd
Edwardsville, IL 62025
Phone (618) 656-8888

1192 Walter St
Ste A
Lemont, IL 60439
Phone (630) 243-2020

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891843652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 MALL LOOP DR",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604311057",
            "telephone_number": "815-436-1800",
            "fax_number": "815-436-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 MALL LOOP DR",
            "address_2": "1532 36 LOUIS JOLIET MALL",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604311057",
            "telephone_number": "815-436-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOURI",
        "first_name": "MARLIN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.