Individual provider Active NPI

Jaclyn Oliver, O.D.

  • Optometrist
  • Wooster, OH
National Provider Identifier
1043662927
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6557 Issued in OH
Practice address
721 E Milltown Rd
Wooster, OH 44691-1331
Phone
(330) 287-4500
NPI assigned
Jul 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 6557 OH
Optometrist 152W00000X 6557 OH Primary

Addresses

Primary practice location

721 E Milltown Rd
Wooster, OH 44691-1331

Mailing address

1562 Rosewood Dr
Wooster, OH 44691-2572
Phone (330) 287-4500

Other identifiers 1

IdentifierTypeStateIssuer
1043662927MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170825001238 OH Practitioner - Optometry 9830482785 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wooster Clinic LLCGroup PAC ID 6800708124, 290 clinicians

Practice addresses (Care Compare)

1740 Cleveland Rd
Wooster, OH 44691-2204
Phone (330) 287-4500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6557OHMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wooster Clinic, LLC CurrentSince Oct 6, 2020 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Sep 8, 2025 Accepting new patients

Locations

21 Sugarbush Ct
Ashland, OH 44805
Phone (419) 289-6466

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

721 E Milltown Rd
Wooster, OH 44691
Phone (330) 287-4500

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1043662927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1562 ROSEWOOD DR",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912572",
            "telephone_number": "330-287-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 E MILLTOWN RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446911331",
            "telephone_number": "330-287-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OH",
            "license": "6557",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "6557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043662927",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.