J. Micetich, OD & Associates Family Eye Care Center P C
Organization Active NPI Optometrist · Coal City, IL
NPI 1093832008 · NPPES record last updated Sep 18, 2012
Key facts
- NPI
- 1093832008
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 046-008925 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Jonathan Edward Micetich, O.D.
- Title
- Optometrist
- Phone
- (815) 634-4825
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 046-008925 | IL | Yes |
Addresses
Primary practice location
20 E North St
Coal City, IL 60416-1087
Mailing address
2920 Gateway Gorge
Morris, IL 60450-9771
Phone (815) 634-4825
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046008925 | Medicaid | IL | |
| 03232003 | Other | IL | BCBS |
| 1740273754 | Other | IL | PERSONAL NPI |
| DR0848 | Other | RAILROAD MEDICARE GROUP PTAN | |
| 410047901 | Other | RAILROAD MEDICARE GROUP MEMBER PTAN |
Other providers in Coal City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.