DR. ALYSSA MICHELLE PETKO (O.D.) – Optometrist, NPI 1336021187

DR. ALYSSA MICHELLE PETKO (O.D.) is a healthcare provider. based in Lake forest, Illinois. specializing in OPTOMETRY. They hold the professional credentials O.D.. They hold a License No. 046.012008 (IL). The NPI Number for DR. ALYSSA MICHELLE PETKO (O.D.) is 1336021187

Main info

Female
Sole Proprietor
1 Year Of Experience
Name
DR. ALYSSA MICHELLE PETKO (O.D.)
NPI
1336021187
Phone
(224) 706-6835
Address
825 S Waukegan Rd Ste C1
Enumeration Date
23 July 2025
Last Update Date
23 July 2025

Doctor Profile

Medical School Name
ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Secondary Phone
-
Graduation Year
2025 (1 year ago)
PAC ID
3870098197
Professional Enrollment ID
I20250926000486
Address ID
IL600131508CA373XXCIRX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Digital endpointsOther names

1,715 OPTOMETRY in IL

Provider Addresses for DR. ALYSSA MICHELLE PETKO (O.D.)

  • 825 S Waukegan Rd Ste C1

    Lake Forest, IL 600452665

    Phone: (224) 706-6835

    Type: Location

  • 5 N WABASH AVE APT 1505

    CHICAGO, IL 606024743

    Phone: (847) 275-1291

    Type: Mailing

  • 111 S FRANKLIN ST

    CHICAGO, IL 606064628

    Phone: (312) 265-0444

    Fax: (312) 929-4213

    Type: Location

  • 25 E Washington St Ste 820

    Chicago, IL 606021700

    Phone: (312) 332-0921

    Fax: (312) 332-0963

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250926000486IOptometryILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60045)

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Reviews

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Frequently asked questions

Is there an official ID for DR. ALYSSA MICHELLE PETKO (O.D.) in U.S. healthcare records?
The official identifier for DR. ALYSSA MICHELLE PETKO (O.D.) is NPI 1336021187.
Is there an active status for DR. ALYSSA MICHELLE PETKO (O.D.)?
For scheduling context, DR. ALYSSA MICHELLE PETKO (O.D.) is shown as active in the registry.
What area of care is associated with DR. ALYSSA MICHELLE PETKO (O.D.)?
DR. ALYSSA MICHELLE PETKO (O.D.)'s record emphasizes Optometrist. Clinical services aligned with this taxonomy classification.
Is DR. ALYSSA MICHELLE PETKO (O.D.) associated with Lake Forest?
Public fields place DR. ALYSSA MICHELLE PETKO (O.D.) around Lake Forest, Illinois. Always confirm the exact site before visiting.
What does 4 location(s) imply?
4 practice locations appear in the available data.

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