MARIAM ETHEZAZ (OD) – Optometrist, NPI 1962996181
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,715 OPTOMETRY in IL
Provider Addresses for MARIAM ETHEZAZ (OD)
1243 W Boughton Rd
Bolingbrook, IL 604401509
Phone: (630) 679-0900
Type: Location
1701 W Larkin Avenue
Crest Hill, IL 604031970
Phone: (815) 741-1140
Type: Location
4777 Northwest Hwy
Crystal Lake, IL 600147340
Phone: (815) 477-8500
Type: Location
2501 W Lawrence Ave
Chicago, IL 606252958
Phone: (773) 931-3839
Type: Location
Isla Pilipina, 2501, West Lawrence Avenue, Bowmanville, Lincoln Square, Chicago, Jefferson Township, Cook County, Illinois, 60625, United States
CHICAGO, IL 606252958
Phone: (773) 801-3757
Fax: (312) 500-5117
Type: Mailing
Willow Road, Glenview, Northfield Township, Cook County, Illinois, 60062, United States
GLENVIEW, IL 600257637
Phone: (847) 832-9690
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $96.
Total Amount is formed as General ($96) + Research ($0) + Ownership ($0) = $96.
Last reported payment date: 2024-08-15 • Largest payer in this snapshot: Alcon Vision LLC ($50).
Total Amount
$96
General + Research + Ownership
Payments
4
Total payment records
General Amount
$96
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alcon Vision LLC | $50 |
| Johnson & Johnson Vision Care, Inc. | $33 |
| GlaxoSmithKline, LLC. | $13 |
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: 2018-10-30
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181030000062 | I | Optometry | IL | TBD |
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.
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 60440)
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