Loretta de Koster,O.D. Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008683 Issued in IL

Legal business name

LORETTA DE KOSTER,O.D. INC.

Practice address

2528 N Harlem Ave
Main Floor
Elmwood Park, IL 60707-2046

Phone

(708) 456-4362

Fax

(708) 456-5161

NPI assigned

Jan 30, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Loretta De Koster, O.D.

Title

Ceo

Phone

(708) 456-4362

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Melrose Eyecare Center Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Haris Dzubur, O.D.

  • Corneal and Contact Management Optometrist
  • Oak Lawn, IL
  • NPI 1760725923
  NPD
• Luma Ali Mallah

  • Optometrist
  • Elmwood Park, IL
  • NPI 1558195453
  NPD
• Carmen A Rad

  • Optometrist
  • Chicago, IL
  • NPI 1487140596
  NPD
• Golie Roshandel Keovan, O.D.

  • Optometrist
  • Chicago, IL
  • NPI 1770601577
  NPD (past)

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334448000000",
    "number": "1992982169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 N HARLEM AVE",
            "address_2": "MAIN FLOOR",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607072046",
            "telephone_number": "708-456-4362",
            "fax_number": "708-456-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 N HARLEM AVE",
            "address_2": "MAIN FLOOR",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607072046",
            "telephone_number": "708-456-4362",
            "fax_number": "708-456-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORETTA DE KOSTER,O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2012-04-15",
        "status": "A",
        "authorized_official_last_name": "DE KOSTER",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-456-4362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01621057",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008683",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IL4407",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melrose Eyecare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judy Lagunas
• Kelsey Libert, M.A.
• Luis A Lim, PT
• Sarah Linder, OTR/L
• Susan Marie Locke, M.D.
• Anuela Lule, PHARMD
• Timothy Lyman, MD
• Suzanne Edita Maier, M.S.
• Malgorzata Elzieta Malkowski
• Luma Ali Mallah

• Optometrist in Elmwood Park, IL
• Providers in Elmwood Park, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.