Provider Demographics
NPI:1881264141
Name:RANDALL R RICKETTS OD LLC
Entity type:Organization
Organization Name:RANDALL R RICKETTS OD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-857-1260
Mailing Address - Street 1:1133 W PRATT BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6781
Mailing Address - Country:US
Mailing Address - Phone:773-857-1260
Mailing Address - Fax:773-857-1640
Practice Address - Street 1:2338 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7043
Practice Address - Country:US
Practice Address - Phone:773-857-1260
Practice Address - Fax:773-857-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003395633OtherNPI
IL1083823611OtherNPI