Judy Chanthalangsy, O.D.
Optometrist in Rockford, IL. Individual provider (NPI-1).
NPI number1053666818
StatusActive
Last updated in NPPESSep 24, 2021
Details
- NPI
- 1053666818
- Entity type
- Individual (NPI-1)
- Name
- Judy Chanthalangsy
- Credential
- O.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 18, 2012
- Certification date
- Sep 24, 2021
- Last updated
- Sep 24, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 046.011481 | IL | Yes |
| 152W00000X | Optometrist | 1888DT | KY |
Practice location
6560 E State StRockford, IL 61108-2545
Phone 815-997-0164
Mailing address
1592 Hunting Hound LnBartlett, IL 60103-1855
Phone 815-997-0164
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 73 Optometrist providers in Rockford · All 5,035 providers in Rockford
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