Active NPI
Jean E. Keskitalo, O.D.
- Optometrist
- Bolingbrook, IL
National Provider Identifier
1386799229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-0007928
- Practice address
- 1112 W Boughton Rd
Bolingbrook, IL 60440-1508 - Phone
- (630) 378-2020
- Fax
- (630) 378-9771
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 046-0007928 | IL | Primary |
Addresses
Primary practice location
1112 W Boughton Rd
Bolingbrook, IL 60440-1508
Mailing address
1315 Green Pheasant LN
Batavia, IL 60510-3081
Phone (630) 879-6304
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-0007928 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386799229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1315 GREEN PHEASANT LN",
"city": "BATAVIA",
"state": "IL",
"postal_code": "605103081",
"telephone_number": "630-879-6304",
"fax_number": "630-378-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 W BOUGHTON RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604401508",
"telephone_number": "630-378-2020",
"fax_number": "630-378-9771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KESKITALO",
"first_name": "JEAN",
"middle_name": "E.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-0007928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.