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4814 N Clark St Ste B Chicago IL 60640-7767 | |
| (773) 897-0800 | |
| (773) 897-0457 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4814 N Clark St Ste B, Chicago, Illinois |
| Authorized Official Name and Position | Andrew Ladochi (OPERATIONS PARTNER) |
| Authorized Official Contact | 7738970800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4814 N Clark St Ste B Chicago IL 60640-7767 Ph: (773) 897-0800 | 4814 N Clark St Ste B Chicago IL 60640-7767 Ph: (773) 897-0800 |
| NPI Number | 1386121283 |
|---|---|
| Provider Enumeration Date | 07/24/2018 |
| Last Update Date | 03/07/2022 |
| Medicare PECOS PAC ID | 7214345008 |
|---|---|
| Medicare Enrollment ID | O20210415001653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386121283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Illinois) | Primary |
| 261QH0100X | Clinic/center - Health Service | (Illinois) | Secondary |
| Provider Name | Puja Desai |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1992050967 PECOS PAC ID: 8022250125 Enrollment ID: I20130819000741 |
| Provider Name | Pamela Marie Marzec |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134472996 PECOS PAC ID: 5092958942 Enrollment ID: I20130826000603 |
| Provider Name | Elijah R Risman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1376030239 PECOS PAC ID: 6103180534 Enrollment ID: I20180510001080 |
| Provider Name | Zachary W Weekes |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1780024091 PECOS PAC ID: 2365850161 Enrollment ID: I20210415001867 |
| Provider Name | Fatima Karim |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1538545611 PECOS PAC ID: 1850641333 Enrollment ID: I20210616002050 |
| Provider Name | Arpit Patel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710595368 PECOS PAC ID: 1254729684 Enrollment ID: I20211103002715 |
| Provider Name | Hina A Lodhia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1952840928 PECOS PAC ID: 0941679062 Enrollment ID: I20221213001127 |
| Provider Name | Dana Hobi |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619590403 PECOS PAC ID: 3779966551 Enrollment ID: I20230403000104 |
| Provider Name | Delia Marie Malone |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790268431 PECOS PAC ID: 2264896083 Enrollment ID: I20230913000739 |
| Provider Name | Todd Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1831202076 PECOS PAC ID: 5597785790 Enrollment ID: I20240306003419 |
| Provider Name | Lisa Nguyen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1699495937 PECOS PAC ID: 9638523806 Enrollment ID: I20240917001916 |
| Provider Name | Rickey Harton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1609861129 PECOS PAC ID: 6507881117 Enrollment ID: I20241010002990 |
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