Individual provider Active NPI

Tehneiyat Macci, O.D.

  • Optometrist
  • Bloomingdale, IL
National Provider Identifier
1982017851
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.010772 Issued in IL
Practice address
152 S Bloomingdale Rd
Bloomingdale, IL 60108-1481
Phone
(630) 980-4446
Fax
(630) 980-2313
NPI assigned
Jun 8, 2014
Last updated
Jan 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010772 IL
Optometrist 152W00000X 046.010772 IL Primary
Corneal and Contact Management Optometrist 152WC0802X 046.010772 IL
Pediatric Optometrist 152WP0200X 046.010772 IL

Addresses

Primary practice location

152 S Bloomingdale Rd
Bloomingdale, IL 60108-1481

Mailing address

152 S Bloomingdale Rd
Bloomingdale, IL 60108-1481
Phone (630) 980-4446

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
I20160408000717 IL Practitioner - Optometry 8729386602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rosin Optical Co IncGroup PAC ID 8022921758, 51 clinicians

Practice addresses (Care Compare)

6233 Cermak Rd
Berwyn, IL 60402-2317
Phone (708) 749-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046010772ILMDOptometrist
046.010772ILMDPediatric Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rosin Optical Co., Inc. Optometrist CurrentSince May 1, 2016 Accepting new patients
Rosin Optical Co., Inc Optometrist Current Accepting new patients
Rosin Optical Co. Inc. Optometrist CurrentSince May 1, 2016 Accepting new patients
Rosin Optical Co., Inc. Optometrist Past Accepting new patients
Rosin Optical Co., Inc. Optometrist PastSince Feb 1, 2022 Accepting new patients
Rosin Optical Co., Inc. Optometrist Past Accepting new patients

Locations

6235 Cermak Rd
Berwyn, IL 60402
Phone (708) 749-2020

145 Ogden Ave
Downers Grove, IL 60515
Phone (630) 749-2020

4196 Il Route 83
#F
Long Grove, IL 60047

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1402185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1982017851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 S BLOOMINGDALE RD",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081481",
            "telephone_number": "630-980-4446",
            "fax_number": "630-980-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 S BLOOMINGDALE RD",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081481",
            "telephone_number": "630-980-4446",
            "fax_number": "630-980-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCI",
        "first_name": "TEHNEIYAT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-08",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010772",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.010772",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "046.010772",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "IL",
            "license": "046.010772",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomingdale, IL

Sources for this page

Verify at the official NPI Registry.