Optical Illusion is a medicare enrolled "Ophthalmology" provider in Toledo, Ohio. Their current practice location is
1000 Regency Ct, Ste 100, Toledo, Ohio. You can reach out to their office (for appointments etc.) via phone at
(419) 882-0588.
Optical Illusion is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Optical Illusion
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1720155534.
Healthcare Provider's Profile
| Full Name | Optical Illusion |
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| Type | Facility |
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| Speciality | Ophthalmology |
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| Location | 1000 Regency Ct, Toledo, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1720155534
- Provider Enumeration Date: 11/29/2006
- Last Update Date: 07/12/2023
Medicare PECOS Information:
- PECOS PAC ID: 0547201444
- Enrollment ID: O20050520000765
Medical Identifiers
Medical identifiers for Optical Illusion such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1720155534 | NPI | - | NPPES |
| CI3304 | Other | OH | RAILROAD MEDCIARE |
| 000000163747 | Other | OH | ANTHEM |
| 2057821 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| 332H00000X | Eyewear Supplier | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Optical Illusion acts as a billing entity for following providers:
| Provider Name | Christina Pacio Tam |
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| Provider Type | Practitioner - Ophthalmology |
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| Provider Identifiers | NPI Number: 1205871787
PECOS PAC ID: 0941250328
Enrollment ID: I20050125000112 |
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| Provider Name | Dino J Costa |
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| Provider Type | Practitioner - Optometry |
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| Provider Identifiers | NPI Number: 1659376978
PECOS PAC ID: 8325089121
Enrollment ID: I20050520000806 |
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| Provider Name | Khalil A Raffoul |
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| Provider Type | Practitioner - Ophthalmology |
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| Provider Identifiers | NPI Number: 1407851736
PECOS PAC ID: 2264548221
Enrollment ID: I20101008000178 |
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| Provider Name | James A Knupp |
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| Provider Type | Practitioner - Ophthalmology |
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| Provider Identifiers | NPI Number: 1548211774
PECOS PAC ID: 0446212633
Enrollment ID: I20130628000504 |
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| Provider Name | John Michael Elchinger |
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| Provider Type | Practitioner - Optometry |
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| Provider Identifiers | NPI Number: 1629505581
PECOS PAC ID: 4789952359
Enrollment ID: I20170622002999 |
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| Provider Name | Sami M Khan |
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| Provider Type | Practitioner - Ophthalmology |
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| Provider Identifiers | NPI Number: 1619400900
PECOS PAC ID: 9638443310
Enrollment ID: I20220712002263 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Optical Illusion is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Optical Illusion
1000 Regency Ct, Ste 100,
Toledo, OH 43623-3074
Ph: (419) 882-0588 | Optical Illusion
1000 Regency Ct, Ste 100,
Toledo, OH 43623-3074
Ph: (419) 882-0588 |
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