JFJ EYECARE, LTD (ILLINOIS EYE SURGEONS) - NPI NUMBER 1376586685

Summary

Provider Name: JFJ EYECARE, LTD (ILLINOIS EYE SURGEONS)

NPI Number: 1376586685

Clasification: Optometrist (152W00000X)

Address:
3990 N ILLINOIS ST
SWANSEA, IL
ZIP 62226

Phone Number: (618) 277-1130



Detailed Information

JFJ EYECARE, LTD is an optometrist in Swansea, IL. The provider is 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. The assigned NPI number for this provider is 1376586685 and is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Illinois Eye Surgeons.

The provider's business address is:

3990 N ILLINOIS ST
SWANSEA, IL
ZIP 62226
Phone: (618) 277-1130
Fax: (618) 277-6651

The provider's authorized official is Bart Aaron Jones .
The authorized official title is Owner and has the following contact phone number (618) 277-1130.

The enumeration date for this NPI number is 6/14/2006 and was last updated on 5/15/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 152W00000X Optometrist Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 554480 MEDICARE PIN IL
2 CF8690 MEDICARE PIN IL
3 CF8691 MEDICARE PIN IL
4 CH6508 MEDICARE PIN IL
5 211586 MEDICARE PIN
6 291990 MEDICARE PIN IL
7 554490 MEDICARE PIN IL

NPI Record

No. Field Name Field Value
1 NPI 1376586685
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name JFJ EYECARE, LTD
5 Provider Other Organization Name ILLINOIS EYE SURGEONS
6 Provider Other Organization Name Type Code 5
7 Provider First Line Business Practice Location Address 3990 N ILLINOIS ST
8 Provider Business Practice Location Address City Name SWANSEA
9 Provider Business Practice Location Address State Name IL
10 Provider Business Practice Location Address Postal Code 62226
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 6182771130
13 Provider Business Practice Location Address Fax Number 6182776651
14 Provider Enumeration Date 6/14/2006
15 Last Update Date 5/15/2012
16 Authorized Official Last Name JONES
17 Authorized Official First Name BART
18 Authorized Official Middle Name AARON
19 Authorized Official Title or Position OWNER
20 Authorized Official Telephone Number 6182771130
21 Healthcare Provider Taxonomy Code 1 152W00000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 554480
24 Other Provider Identifier Type Code 1 08
25 Other Provider Identifier State 1 IL
26 Other Provider Identifier 2 CF8690
27 Other Provider Identifier Type Code 2 08
28 Other Provider Identifier State 2 IL
29 Other Provider Identifier 3 CF8691
30 Other Provider Identifier Type Code 3 08
31 Other Provider Identifier State 3 IL
32 Other Provider Identifier 4 CH6508
33 Other Provider Identifier Type Code 4 08
34 Other Provider Identifier State 4 IL
35 Other Provider Identifier 5 211586
36 Other Provider Identifier Type Code 5 08
37 Other Provider Identifier 6 291990
38 Other Provider Identifier Type Code 6 08
39 Other Provider Identifier State 6 IL
40 Other Provider Identifier 7 554490
41 Other Provider Identifier Type Code 7 08
42 Other Provider Identifier State 7 IL
43 Is Organization Subpart N
44 Authorized Official Credential Text MD
45 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
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