Active NPI
Jody L Ricketts, OD
- Optometrist
- Libertyville, IL
National Provider Identifier
1205939683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-008169
- Practice address
- 730 N Milwaukee Ave
Libertyville, IL 60048-1914 - Phone
- (847) 362-9900
- Fax
- (847) 362-9936
- NPI assigned
- Sep 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-008169 | IL | Primary |
Addresses
Primary practice location
730 N Milwaukee Ave
Libertyville, IL 60048-1914
Mailing address
730 N Milwaukee Ave
Libertyville, IL 60048-1914
Phone (847) 362-9900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008169 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brain-Eye Evolution at 730 North | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Vision Therapy Optometrist
- Libertyville, IL
- NPI 1851741714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370217600000",
"number": "1205939683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 N MILWAUKEE AVE",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600481914",
"telephone_number": "847-362-9900",
"fax_number": "847-362-9936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 N MILWAUKEE AVE",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600481914",
"telephone_number": "847-362-9900",
"fax_number": "847-362-9936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKETTS",
"first_name": "JODY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2013-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-008169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
- Suzanne Kniepkamp Rice, MSN AGACNP-BC
- Richard P Reinherz DPM & Mary G Kwiecinski DPM PTR Family Foot Care
- Richard P Weber Psy.D.
- Sarah Richards, MS
- Jordan Miranda Richmond, PT, DPT
- Lucy Rickspoone, PSY. D.
- Jennifer Martin Rieck, LCPC
- Mark Riederman, M.D.
- Sarah Elizabeth Rieger, M.S., BCBA
- Jack Rieke, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.