Eric Jon Petecki, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009282 Issued in IL

Practice address

1230 N Cedar Rd Unit a
New Lenox, IL 60451-1272

Phone

(815) 485-6533

Fax

(815) 485-6534

NPI assigned

Oct 24, 2006

Sex

Male

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

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

Illinois College of Optometry at Chicago, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Lenox Family Eyecare LTDGroup PAC ID 9739114513, 3 clinicians

Practice addresses (Care Compare)

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.

• New Lenox Family Eyecare LTD

  • Optometrist
  • New Lenox, IL
  • NPI 1447462288
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1508940123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 N CEDAR RD UNIT A",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511272",
            "telephone_number": "815-485-6533",
            "fax_number": "815-485-6534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N CEDAR RD UNIT A",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511272",
            "telephone_number": "815-485-6533",
            "fax_number": "815-485-6534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "352 W Maple St",
            "address_purpose": "LOCATION",
            "city": "New Lenox",
            "state": "IL",
            "postal_code": "604512953",
            "country_code": "US",
            "telephone_number": "815-485-6533",
            "fax_number": "815-485-6534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETECKI",
        "first_name": "ERIC",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "046009282",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica L Pecho, PA-C
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• Jose Antonio Penaherrera, M.D.
• Mia Y Perri
• Tecya Peterson, LSW
• Robert Pieczynski
• Gamilah N. Pierre, M.D.
• Arnold Victor Pilmonas
• Loreal Jeanne Pinder, LMT

• Optometrist in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.