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DR. THOMAS J BALDA OD
NPI 1396820858
Optometrist in Lake Zurich, IL

Active since October 25, 2006PECOS EnrolledAccepts Medicare Assignment
950 W MAIN ST, SUITE 125, LAKE ZURICH, IL 60047(847) 726-2020(847) 726-2036 Get Directions Write a Review

NPPES record last updated: September 16, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 16, 2025, May 13, 2024, Jul 24, 2020 (3 updates tracked since 2020).

About Dr. Thomas J Balda Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. THOMAS J BALDA OD (NPI 1396820858) is an individual optometrist in Lake Zurich, Illinois, licensed in Missouri (2024041934) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Gravois Mills, and is a graduate of Illinois College Of Optometry At Chicago (1993).

NPPES Registry Identity

NPI1396820858
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. THOMAS J BALDACredential: OD
Location Address950 W MAIN ST, SUITE 125Lake Zurich, IL 60047
Mailing Address8614 Westwood Center Dr Fl 9Vienna, VA 22182-2442 · (703) 847-8899 · Fax (571) 223-6780
Phone(847) 726-2020
Fax(847) 726-2036
Sole ProprietorNo
Medical School CMSIllinois College Of Optometry At ChicagoGraduated 1993
Enumeration DateOctober 25, 2006
Last NPPES UpdateSeptember 16, 20253 updates tracked since enumeration
NPPES CertifiedSeptember 16, 2025
✔ NPI 1396820858 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in MO · 2024041934✔ Licensed in IL · 046008673
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
950 W MAIN ST, Lake Zurich, IL 60047
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Secondary Practice Location 1

Location 1138 S Main StGravois Mills, MO 65037-6196 · Phone (573) 374-5222

Other Identifiers 1

Medicaid046008673IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Thomas J Balda Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6103845474
PECOS Enrollment IDI20251023001144
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Thomas Balda reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Myeyedr Optometry Of Illinois, LLC
2.0 mi
Optometrist
950 W STATE ROUTE 22
Lake Zurich, IL 60047
  • Reassigned Medicare billing, Illinois enrollment
  • 114 clinicians in this Medicare group
NPI 1972085033 (847) 726-2020
Paige Hedgpath Odpc
317 mi
Optometrist
1400 FORUM BLVD
Columbia, MO 65203
  • Reassigned Medicare billing, Missouri enrollment
  • 83 clinicians in this Medicare group
NPI 1669530887 (573) 446-0331

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of cataract with insertion of prosthetic lens 66984
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
1,691 services13 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
104 services89 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
69 services69 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
58 services45 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
52 services50 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
18 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60047 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$74.38 typical visit price
range $19.15 – $147.12
Typical copayment $18.59 (range $4.78 – $36.78)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIMBERLY V ROBERTSON OD
Optometrist
950 W MAIN ST, SUITE 125
LAKE ZURICH, IL 60047
Lake County (847) 726-2020
KENNETH J. LOSSMAN, O.D., P.C.
Optometrist
950 W MAIN ST, SUITE 125
LAKE ZURICH, IL 60047
Lake County (847) 726-2020
DR. ELIZABETH JEAN SOSINSKI D.P.M.
Podiatrist
950 W MAIN ST, SUITE 105
LAKE ZURICH, IL 60047
Lake County (847) 540-0234
LAKE ZURICH PODIATRY PC
Podiatrist
950 W MAIN ST, SUITE 105
LAKE ZURICH, IL 60047
Lake County (847) 540-0234
DR. KENNETH J LOSSMAN OD
Optometrist
950 W MAIN ST, SUITE 125
LAKE ZURICH, IL 60047
Lake County (847) 726-2020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thomas Balda's NPI number?

The NPI number for Thomas Balda is 1396820858. It was assigned to this individual provider in the NPPES registry on October 25, 2006.

Where is Thomas Balda located?

Thomas Balda practices at 950 W Main St Suite 125, Lake Zurich, IL 60047. The listed phone number is (847) 726-2020.

What is Thomas Balda's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Thomas Balda enrolled in Medicare?

Yes. Thomas Balda is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Thomas Balda's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Thomas Balda reassigns Medicare benefits to 2 organizations: Myeyedr Optometry Of Illinois, LLC (Lake Zurich, IL) and Paige Hedgpath Odpc (Columbia, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Thomas Balda's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Thomas Balda accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 14 other insurers list Thomas Balda as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Thomas Balda was last updated on September 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.