Jacqueline Marie Carlock, OD
Individual provider Active NPI Optometrist · Lemont, IL
NPI 1124154620 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124154620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- Practice address
- 15531 127TH St
Lemont, IL 60439 - Phone
- (630) 243-9895
- Fax
- (630) 257-2503
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141009000920 | IL | Practitioner - Optometry | 4688897366 | Practice locations: Homer Glen, IL; Lemont, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IL | Yes |
Addresses
Primary practice location
15531 127TH St
Lemont, IL 60439
Mailing address
15531 127TH St
Lemont, IL 60439
Phone (630) 243-9895
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001633030 | Other | IL | BLUE CROSS BLUE SHEILD |
Other providers in Lemont, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.