J. Micetich, OD & Associates Family Eye Care Center P C

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008925 Issued in IL

Legal business name

J. MICETICH, OD & ASSOCIATES FAMILY EYE CARE CENTER P C

Practice address

20 E North St
Coal City, IL 60416-1087

Phone

(815) 634-4825

NPI assigned

Mar 23, 2007

Last updated

Sep 18, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Edward Micetich, O.D.NPI 1740273754

Title

Optometrist

Phone

(815) 634-4825

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Edward Micetich, O.D.

  • Optometrist
  • Coal City, IL
  • NPI 1740273754
  Authorized official Same address or phone

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1093832008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 GATEWAY GORGE",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604509771",
            "telephone_number": "815-634-4825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E NORTH ST",
            "city": "COAL CITY",
            "state": "IL",
            "postal_code": "604161087",
            "telephone_number": "815-634-4825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. MICETICH, OD & ASSOCIATES FAMILY EYE CARE CENTER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "MICETICH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "815-634-4825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Domenico Giustino
• Stephanie Gralewski
• Emily Ann Halliday
• Brandi Ann Hamrick, DC
• Highland Park CVS, L.L.C. (CVS Pharmacy #10599)
• John D Scala MD PC
• Stacey Johnson, FNP/BC
• Gaurav Kapoor, MD
• Jane Louise Kapral, M.D.
• Erica Robin Krahl, MA

• Optometrist in Coal City, IL
• Providers in Coal City, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.