Kaylyn Marie Nickelson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011215 Issued in IL

Practice address

2020 W Iles Ave
Springfield, IL 62704-7015

Phone

(217) 698-3030

Fax

(217) 718-5687

NPI assigned

Jul 30, 2018

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 identifiers 1

Other names 1

• Kaylyn Marie Yakel 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

Specialty

Optometry

Education

Indiana University - School of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prairie Eye Center, LTDGroup PAC ID 6507779824, 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.63 of 100Reported as group

Quality

90.15

Improvement activities

40

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 and National Provider Directory roles.

• Prairie Eye Center, LTD

  • Ophthalmology Physician
  • Springfield, IL
  • NPI 1447222864

  Optometrist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1467930735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047015",
            "telephone_number": "217-698-3030",
            "fax_number": "217-698-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047015",
            "telephone_number": "217-698-3030",
            "fax_number": "217-718-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "KAYLYN",
        "middle_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046011215",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLYN",
            "last_name": "YAKEL",
            "middle_name": "MARIE",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Phyllis J Nichols, RN
• Kathleen Dawn Nicholson-Schahl, MOT, OTR/L
• Nicole Nicholson, LCSW
• Sheila M. Nicholson, P.T., M.S.
• Gayla J Nickel, COTA
• Melissa A. Nicol, DIETICIAN
• Sarah Nicolas
• Daniel J Niebrugge, M.D.
• Emily Nielsen, FNP
• Niemann Foods Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.