Mariam Ethezaz, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011188 Issued in IL

Practice address

2305 Willow Rd
Glenview, IL 60025-7637

Phone

(847) 832-9690

NPI assigned

Jun 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lincoln Square Optical

  • Optometrist
  • Chicago, IL
  • NPI 1346716768
  Medicare reassignment NPD Authorized official
• Rosin Optical Co., Inc

  • Optometrist
  • Berwyn, IL
  • NPI 1235343641
  Medicare reassignment NPD
• Rosin Optical Co. Inc.

  • Optometrist
  • Skokie, IL
  • NPI 1750945408
  NPD
• Rosin Optical Co., Inc.

  • Optometrist
  • Belvidere, IL
  • NPI 1417408774
  NPD

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1962996181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252958",
            "telephone_number": "773-801-3757",
            "fax_number": "312-500-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 WILLOW RD",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257637",
            "telephone_number": "847-832-9690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1243 W Boughton Rd",
            "address_purpose": "LOCATION",
            "city": "Bolingbrook",
            "state": "IL",
            "postal_code": "604401509",
            "country_code": "US",
            "telephone_number": "630-679-0900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4777 Northwest Hwy",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147340",
            "country_code": "US",
            "telephone_number": "815-477-8500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 W Larkin Avenue",
            "address_purpose": "LOCATION",
            "city": "Crest Hill",
            "state": "IL",
            "postal_code": "604031970",
            "country_code": "US",
            "telephone_number": "815-741-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2501 W Lawrence Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606252958",
            "country_code": "US",
            "telephone_number": "773-931-3839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHEZAZ",
        "first_name": "MARIAM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Franzina J Espedido
• Melissa Espinal, PT
• Cynthia Esquivel, PT, DPT
• Essence of Home Care LLC
• Alexandra Nicole Etheridge
• Evan L Lipkis MD SC
• John C Evans, M.D.
• Joshua T Evans
• Evolve Chiropractic Glenview PLLC
• Allison Ewing-Elias, LCSW

• Optometrist in Glenview, IL
• Providers in Glenview, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.