Jack B Vontillius, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD0000002781 Issued in TN

Practice address

9453 Dayton Pike
Soddy Daisy, TN 37379-4751

Phone

(423) 332-8222

Fax

(423) 332-8278

NPI assigned

Nov 21, 2007

Last updated

Jun 27, 2013By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pearle Vision Inc

  dba Pearle Vision #C6672

  • Eyewear Supplier
  • Fairview Heights, IL
  • NPI 1982744033
  NPD (past)

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1194906883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9453 DAYTON PIKE",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373794751",
            "telephone_number": "423-332-8222",
            "fax_number": "423-332-8278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9453 DAYTON PIKE",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373794751",
            "telephone_number": "423-332-8222",
            "fax_number": "423-332-8278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONTILLIUS",
        "first_name": "JACK",
        "middle_name": "B",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-21",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007223",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD0000002781",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OP002631",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura T Truelove, MD
• William David Van Eaton, PT
• Danielle A Vandergriff, NP
• Vision Plus Optical
• Vital Medical Transport (Vital Medical Transport, LLC)
• Danielle Sarah Voss, APRN
• VPT Performance
• VPT Performance LLC
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0477)
• Wal-Mart Stores East, LP (Vision Center 30-0477)

• Optometrist in Soddy Daisy, TN
• Providers in Soddy Daisy, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.