Jeffrey S Porter OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

04608991 Issued in IL

Legal business name

JEFFREY S PORTER OD PC

Practice address

1205 S Il Route 31
Crystal Lake, IL 60014-8213

Phone

(915) 477-4053

Fax

(815) 477-4302

NPI assigned

Dec 26, 2007

Organization subpart

No

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

Authorized official

Name

Jeffrey Scott Porter, O.D.NPI 1982747507

Title

President

Phone

(847) 323-8501

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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.

• Jeffrey Scott Porter, O.D.

  • Optometrist
  • Crystal Lake, IL
  • NPI 1982747507
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1356525489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3912 VALLEY VIEW RD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600122104",
            "telephone_number": "815-479-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148213",
            "telephone_number": "915-477-4053",
            "fax_number": "815-477-4302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY S PORTER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-323-8501",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "04608991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy T Jantz, D.P.M.
• Eliza Janus
• Elayne Jarvis, DEVELOPMENTAL THERAP
• Shafaq Javaid, LCPC
• Kirsten Nicole Jefferson, CADC
• Jenny Baruch DDS PC
• Hyojin Jeon, MD
• JH Counseling Services, LLC
• JJJ Home Care Inc
• Jkcatahay LLC

• Optometrist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.