Denise Marie Jacquin, O.D.
Individual provider Active NPI Optometrist · Wood River, IL
NPI 1124240569 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124240569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- Practice address
- 650 Wesley Drive
Wood River Centre
Wood River, IL 62095 - Phone
- (618) 258-1002
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008654 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Vision, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IL | Yes |
Addresses
Primary practice location
650 Wesley Drive
Wood River Centre
Wood River, IL 62095
Mailing address
7 Cross County CT.
Jerseyville, IL 62052
Phone (618) 223-0577
Other names
- Dr. Denise Bishop
Other providers in Wood River, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.