Fof Optical PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

FOF OPTICAL PLLC

Doing business as

The Optical Edge

Practice address

372 Larry Power Rd
Bourbonnais, IL 60914-5190

Phone

(708) 805-7618

NPI assigned

Feb 7, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Marie Jeziorny Kerouac, ODNPI 1588951222

Title

Optometrist

Phone

(708) 805-7618

Specialties & licenses 1

Addresses

Other names 1

• The Optical Edge Doing business as

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, and the practitioner matching its NPPES authorized official.

• Lisa Marie Jeziorny Kerouac, O.D.

  • Optometrist
  • Bourbonnais, IL
  • NPI 1588951222
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1738886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1528873684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1158 LAFITE",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144538",
            "telephone_number": "708-805-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 LARRY POWER RD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145190",
            "telephone_number": "708-805-7618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOF OPTICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-07",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "JEZIORNY KEROUAC",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "708-805-7618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Optical Edge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Optical Edge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marc L Fisher, M.D.
• Five Apples Inpatient Specialists (Terrill Applewhite,M.D.)
• Jocelyn Flores
• Michelle Flores, LCPC
• Focused Healing PLLC
• Scott Paul Fogel, DDS
• Foot Health Center
• Amy Lynn Forbes, LCPC
• Pamela A. Ford, LCPC CADC ATE
• Foster Chiropractic S.C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.