Active NPI
D David Pesavento, OD
- Optometrist
- Joliet, IL
National Provider Identifier
1992755516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046007408
- Practice address
- 963 129TH Infantry Dr
Suite 110
Joliet, IL 60435 - Phone
- (815) 725-8425
- Fax
- (815) 725-2607
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046007408 | IL | Primary |
Addresses
Primary practice location
963 129TH Infantry Dr
Suite 110
Joliet, IL 60435
Mailing address
963 N 129TH Infantry Dr
Suite110
Joliet, IL 60435-3104
Phone (815) 725-8425
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MP1396387 | Other | PEA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1992755516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "963 N 129TH INFANTRY DR",
"address_2": "SUITE110",
"city": "JOLIET",
"state": "IL",
"postal_code": "604353104",
"telephone_number": "815-725-8425",
"fax_number": "815-725-2607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "963 129TH INFANTRY DR",
"address_2": "SUITE 110",
"city": "JOLIET",
"state": "IL",
"postal_code": "60435",
"telephone_number": "815-725-8425",
"fax_number": "815-725-2607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESAVENTO",
"first_name": "D",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046007408",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEA",
"identifier": "MP1396387",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.