NPIMap

Organization Active NPI

Dekalb Eye Consultants, LLC

Doing business as Lakeside Eye Group

  • Optometrist
  • Chicago, IL
National Provider Identifier
1952817843
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DEKALB EYE CONSULTANTS, LLC
Doing business as
Lakeside Eye Group
Practice address
1 E Wacker Dr
Chicago, IL 60601-1474
Phone
(312) 553-1818
Fax
(312) 641-5503
NPI assigned
Dec 14, 2017
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
George L Neal
Title
Chief Executive Officer
Phone
(469) 214-0144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Ophthalmology Physician 207W00000X NU

Addresses

Primary practice location

1 E Wacker Dr
Chicago, IL 60601-1474

Mailing address

1630 Gateway Dr
Sycamore, IL 60178-3182
Phone (815) 756-8571

Other names 1

  • Lakeside Eye Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dekalb Eye Consultants LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1513209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1952817843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 GATEWAY DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783182",
            "telephone_number": "815-756-8571",
            "fax_number": "815-756-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E WACKER DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606011474",
            "telephone_number": "312-553-1818",
            "fax_number": "312-641-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB EYE CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-14",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Eye Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeside Eye Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.