Peter Damien Jacques, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2019039864 Issued in MO

Practice address

16972 Manchester Rd
Wildwood, MO 63040-1200

Phone

(636) 477-5187

NPI assigned

Oct 23, 2019

Last updated

Sep 7, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MO

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

University of Missouri St Louis - School of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacques Optometry LLC

  dba Rockwood Eyecare

  • Optometrist
  • Wildwood, MO
  • NPI 1386217586
  Medicare reassignment NPD Authorized official
• Overland Optical, Inc.

  dba Overland Optical Family Eye Care

  • Optician
  • Saint Louis, MO
  • NPI 1457377848
  Medicare reassignment NPD
• Overland Optical, Inc

  dba Overland Optical Family Eye Care

  • Optician
  • Saint Charles, MO
  • NPI 1396833174
  NPD (past)

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1558904409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16972 MANCHESTER RD",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401200",
            "telephone_number": "636-477-5187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16972 MANCHESTER RD",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401200",
            "telephone_number": "636-477-5187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "PETER",
        "middle_name": "DAMIEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-23",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2019039864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rena A Isenogle, RPH
• Brenda Gail Izen, M.D.
• Eve Jacobs, CNM
• Jacques Optometry LLC (Rockwood Eyecare)
• Lisa Jacques
• Julie Ann James, PT, FDNP
• Kiersten Jamison
• Mari E. Janko, PA
• Alexandra Johler, DC MS
• Jon Copeland DDS LLC (Town Center Dental)

• Optometrist in Wildwood, MO
• Providers in Wildwood, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; 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.