Myeyedr Optometry of Illinois, LLC
Organization Active NPI Optometrist · Coal City, IL
NPI 1972180149 · NPPES record last updated May 26, 2022
Key facts
- NPI
- 1972180149
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MYEYEDR OPTOMETRY OF ILLINOIS, LLC
- Practice address
- 20 E North St
Coal City, IL 60416-1087 - Phone
- (815) 634-4825
- Fax
- (815) 634-4938
- NPI assigned
- Mar 25, 2021
- Organization subpart
- No
Authorized official
- Name
- Sue Downes
- Title
- Secretary
- Phone
- (703) 847-8899
Practitioners 3
-
Jennifer Wai-Ling Chu, O.D.
-
Nisha B Jani-Konduri, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160310001870 | IL | Part B Supplier - Clinic/Group Practice | 3577869965 |
Receives reassigned benefits from 113 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
20 E North St
Coal City, IL 60416-1087
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other names
- MyEyeDr.
Other providers in Coal City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.