David Phan, OD
Individual provider Active NPI Optometrist · Chicago, IL
NPI 1972099307 · NPPES record last updated Jul 11, 2018
Key facts
- NPI
- 1972099307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046.011205 (IL)
- Practice address
- 1753 E 95TH St Ste B-100
Chicago, IL 60617 - Phone
- (773) 364-4938
- NPI assigned
- Jul 9, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Eyecare PC
Practice addresses (Care Compare)
5222 Main St
Manchester Center, VT 05255-9700
Phone (802) 366-8050
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250123001412 | VT | Practitioner - Optometry | 8628507415 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.011205 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Eyecare PC | Optometrist | Current |
Accepting new patients |
| National Vision, Inc. | Past | Accepting new patients | |
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients | |
| Advanced Eyecare, PC | Past |
Accepting new patients | |
| National Vision Inc | Optometrist | Past | Accepting new patients |
| America'S Best Contacts and Eyeglasses | Past | Accepting new patients |
Locations
322 Dewey St
Bennington, VT 05201
Phone (802) 447-8700
5222 Main St
Manchestr Ctr, VT 05255
Phone (802) 366-8050
Interoperability endpoints
- dphan@adveyecarevt.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.011205 | IL | Yes |
Addresses
Primary practice location
1753 E 95TH St Ste B-100
Chicago, IL 60617
Mailing address
4840 N Sheridan Rd Apt 1
Chicago, IL 60640-4048
Phone (312) 330-7005
Other practice location 1
1400 W 47th St
Chicago, IL 60609-3232
Phone (773) 640-5384
Other practice location 2
205 W 87th St Ste D
Chicago, IL 60620-1321
Phone (773) 496-5433
Other practice location 3
4741 W Cermak Rd
Cicero, IL 60804-2508
Phone (708) 391-1763
Other practice location 4
11750 S Marshfield Ave
Chicago, IL 60643-4904
Phone (773) 568-3479
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.