NPIMap

Organization Active NPI

Jasper Gulotta

  • Optometrist
  • South Holland, IL
National Provider Identifier
1497937403
Registry record updated Aug 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JASPER GULOTTA
Practice address
835 E 162ND St
South Holland, IL 60473-2465
Phone
(708) 333-4444
Fax
(708) 333-4454
NPI assigned
Nov 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2009

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

Authorized official

Name
Dr. Jasper Jay Gulotta, O.D.
Title
Owner
Phone
(708) 333-4444

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

835 E 162ND St
South Holland, IL 60473-2465

Mailing address

835 E 162ND St
South Holland, IL 60473-2465
Phone (708) 333-4444

Other names 1

  • South Holland Optometric Associates Doing business as

National Provider Directory

National Provider Directory

Locations

835 E 162nd St
South Holland, IL 60473
Phone (312) 333-4444

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1497937403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 E 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732465",
            "telephone_number": "708-333-4444",
            "fax_number": "708-333-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 E 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732465",
            "telephone_number": "708-333-4444",
            "fax_number": "708-333-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASPER GULOTTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "GULOTTA",
        "authorized_official_first_name": "JASPER",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-333-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Holland Optometric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.