Active NPI
John Everd Brothers, O.D.
- Optometrist
- Danville, IL
National Provider Identifier
1104899053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-007703
- Practice address
- 1104 N Vermilion St
Chittick Family Eye Care
Danville, IL 61832-3094 - Phone
- (217) 442-2631
- Fax
- (217) 442-0119
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-007703 | IL | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 046-007703 | IL |
Addresses
Primary practice location
1104 N Vermilion St
Chittick Family Eye Care
Danville, IL 61832-3094
Mailing address
1901 Kensington Knoll Dr
Champaign, IL 61822-8537
Phone (217) 359-4111
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16361 | Other | IL | COLE MANAGED VISION |
| 216981 | Other | IL | PERSONAL CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-007703 | IL | MD | Corneal and Contact Management Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pearle Vision Inc | Past | Accepting new patients |
Organizations & group practices 1
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": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412812800000",
"number": "1104899053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 KENSINGTON KNOLL DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618228537",
"telephone_number": "217-359-4111",
"fax_number": "217-459-9870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 N VERMILION ST",
"address_2": "CHITTICK FAMILY EYE CARE",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618323094",
"telephone_number": "217-442-2631",
"fax_number": "217-442-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROTHERS",
"first_name": "JOHN",
"middle_name": "EVERD",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2014-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-007703",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "IL",
"license": "046-007703",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLE MANAGED VISION",
"identifier": "16361",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CARE",
"identifier": "216981",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.