Dr. Jeanette Jezick OD., LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

002353 Issued in CT

Legal business name

DR. JEANETTE JEZICK OD., LLC

Doing business as

Eyecare Expressions

Practice address

1663 Route 12
Gales Ferry, CT 06335-1500

Phone

(860) 464-1040

Fax

(860) 464-1044

NPI assigned

Oct 27, 2009

Last updated

Oct 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Wilbanks

Title

Manager

Phone

(860) 464-1040

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eyecare Expressions Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeanette Jezick, OD

  • Optometrist
  • Gales Ferry, CT
  • NPI 1922019918
  Medicare reassignment NPD

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1144556192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 ROUTE 12",
            "address_2": "PO BOX 421",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351500",
            "telephone_number": "860-464-1040",
            "fax_number": "860-464-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 ROUTE 12",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351500",
            "telephone_number": "860-464-1040",
            "fax_number": "860-464-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JEANETTE JEZICK OD., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "WILBANKS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-464-1040"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED PTAN",
            "identifier": "410000975",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004132429",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Expressions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindsay J D'Amato
• Karen L Daly, D.D.S.
• Colleen M Devine, LMFT
• Steven Joseph Dias, DDS
• Melissa Maria Doukas, NBC-HWC
• Eastern Connecticut Rehabili
• Kathleen Ann Epperson, OTR
• Charles R Esposito, M.D.
• Michael Fogge, DDS, MS
• Steven H. Forstein, M.D.

• Optometrist in Gales Ferry, CT
• Providers in Gales Ferry, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.