Jacksoneye SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

JACKSONEYE SC

Practice address

300 N Milwaukee Ave
Suite L
Lake Villa, IL 60046

Phone

(847) 356-0700

Fax

(847) 356-0757

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mitchell Alin Jackson, MDNPI 1902958929

Title

Ceo Owner

Phone

(847) 356-0700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

Enrollment records 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mitchell Alin Jackson, MD

  • Ophthalmology Physician
  • Lake Villa, IL
  • NPI 1902958929

  WI

  Medicare reassignment Care Compare group NPD Authorized official
• Melissa Kay Bollinger, O.D.

  • Optometrist
  • New Lenox, IL
  • NPI 1578640215
  Medicare reassignment Care Compare group NPD
• Vanee V Virasch, MD

  • Ophthalmology Physician
  • Chicago, IL
  • NPI 1740459403
  Medicare reassignment NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073669834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N MILWAUKEE AVE",
            "address_2": "SUITE L",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "60046",
            "telephone_number": "847-356-0700",
            "fax_number": "847-356-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MILWAUKEE AVE",
            "address_2": "SUITE L",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "60046",
            "telephone_number": "847-356-0700",
            "fax_number": "847-356-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONEYE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "ALIN",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "847-356-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0004932263",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Herrndobler, LPC
• Ramona C Hickey
• Laura Houston, SLP
• Kathleen L Hufnagle, D.C.
• Mitchell Alin Jackson, MD
• Deana Lynn Jaros, DT
• Danielle Jin, PHARMD
• Elaine Johnson
• Victor Jorden, M.D., M.P.H.
• Terryll Eli Joy, MD

• Ophthalmology Physician in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.