Pamela Jean Eilenfeldt, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008618 Issued in IL

Practice address

1265 N Henderson St
Galesburg, IL 61401-1510

Phone

(309) 343-7799

Fax

(309) 343-7934

NPI assigned

Jan 8, 2007

Last updated

Jun 30, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Pamela Jean Mikulecky Former name

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr Eric Botts and Associates LLCGroup PAC ID 5991858011, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr Eric Botts & Associates LLC

  • Optometrist
  • Macomb, IL
  • NPI 1710180922
  Medicare reassignment Care Compare group NPD
• Shopko Stores Operating Co. LLC

  dba ShopKo Optical 060

  • Eyewear Supplier
  • Albert Lea, MN
  • NPI 1528010642
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404086400000",
    "number": "1114075645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8309 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152170",
            "telephone_number": "309-693-9540",
            "fax_number": "309-693-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 N HENDERSON ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011510",
            "telephone_number": "309-343-7799",
            "fax_number": "309-343-7934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EILENFELDT",
        "first_name": "PAMELA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008618",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "MIKULECKY",
            "middle_name": "JEAN",
            "prefix": "DR.",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brett Andrew Eandi, PHYSICIAN ASSISTANT
• Tasha N Easley, LCPC
• Edith Morgan Ecklund, M.S., BCBA
• Carrie Edwards
• Shannon L Egan, APRN,CNP
• Chris A Elliott, PHARMD
• Hannah Emery, SLP
• Endearing Hearts Home Care LLC
• Kari Endres, FNP
• Melissa Engebretson, P.T.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.