Jay E Tallis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-007271 Issued in IL

Practice address

915 N Main St
Bloomington, IL 61701-3043

Phone

(309) 827-8434

Fax

(309) 828-6741

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• J.E. Tallis Dba American Vision Center

  • Optometrist
  • Bloomington, IL
  • NPI 1164698148
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417132800000",
    "number": "1083627830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N MAIN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013043",
            "telephone_number": "309-827-8434",
            "fax_number": "309-828-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N MAIN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013043",
            "telephone_number": "309-827-8434",
            "fax_number": "309-828-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLIS",
        "first_name": "JAY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2014-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-007271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007271",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colton Wayne Sylvester, D.M.D
• Karen Szypura
• Zoey Marie Tackett
• Benjamin Taimoorazy, MD
• Tallis Optometry, PLLC
• Hillary Tanner-Dixon
• Abby Taplin, MA
• Anna Marie Taravella, M.S.
• Kiara A Tate
• Chad Tattini

• Optometrist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.