Jack G Vukov, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036051323 Issued in IL

Practice address

2100 18TH Ave Ste 4
Rock Island, IL 61201-3611

Phone

(309) 788-8887

NPI assigned

Aug 24, 2006

Last updated

Apr 23, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Loyola University of Chicago, Stritch School of Medicine, 1974

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1194832022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 18TH AVE STE 4",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612013611",
            "telephone_number": "309-788-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 18TH AVE STE 4",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612013611",
            "telephone_number": "309-788-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VUKOV",
        "first_name": "JACK",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036051323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0008100304",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINA STAR",
            "identifier": "0335320001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tavia Marie Vital, RN, CDE
• Theodore Eric Vogel-Wilson
• Heidi Vorac
• Aaron Vosberg
• Sandra J Voss, LSW, LMSW
• Danielle Jillian Waddle, LMSW
• Archana G Wagle, MD
• Nikhil Sudhakar Wagle, MD
• Haley Wagler
• Kylie Waldbusser

• Ophthalmology Physician in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.