Jerilyn Kay Prybell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008426 Issued in IL

Practice address

312 Tri State Pkwy
Ste 100
Gurnee, IL 60031-5283

Phone

(847) 623-3937

Fax

(847) 623-9836

NPI assigned

Nov 6, 2006

Last updated

May 26, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jerilyn Kay Kofman Former name

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• In Focus Eyecare P.C.

  • Optometrist
  • Algonquin, IL
  • NPI 1053723908
  Medicare reassignment NPD
• Myeyedr Optometry of Illinois, LLC

  • Optometrist
  • Chicago, IL
  • NPI 1154297752
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401062400000",
    "number": "1295814572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27428 LA VISTA DR",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600605002",
            "telephone_number": "847-623-3937",
            "fax_number": "847-623-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 TRI STATE PKWY",
            "address_2": "STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315283",
            "telephone_number": "847-623-3937",
            "fax_number": "847-623-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYBELL",
        "first_name": "JERILYN",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERILYN",
            "last_name": "KOFMAN",
            "middle_name": "KAY",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Progar, PSYD
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• Provida Health Center SC (Provida Family Medicine)
• Susan Elizabeth Prust, PT DIP MDT
• Victoria G Pugh
• Kelly Jean Purcell, PA-C
• Pure Physical Therapy LLC
• Arthur Warren Purkel Jr., PH.D.
• Vidya Jaganath Puthenveetil, M.D.

• Optometrist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2014; 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.