Jerome Charles Lietz, OD

Primary specialty

OptometristTaxonomy code 152W00000X

Practice address

1701 N Larkin Ave
Suite 105
Crest Hill, IL 60403

Phone

(815) 741-1140

Fax

(815) 741-8449

NPI assigned

Sep 28, 2006

Last updated

Jul 8, 2007By 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 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Ziva Optical II, LTD.

  dba Pearle Vision

  • Optometrist
  • Crystal Lake, IL
  • NPI 1104957828
  NPD (past)
• Ziva Optical, LTD.

  dba Pearle Vision

  • Optometrist
  • Bolingbrook, IL
  • NPI 1578694386
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609968650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 N LARKIN AVE",
            "address_2": "SUITE 105",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "60403",
            "telephone_number": "815-741-1140",
            "fax_number": "815-741-8449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N LARKIN AVE",
            "address_2": "SUITE 105",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "60403",
            "telephone_number": "815-741-1140",
            "fax_number": "815-741-8449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIETZ",
        "first_name": "JEROME",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• June Eunjeong Lee, FNP-BC
• Randy Lee Jr., D.N.
• Daniel Terrence Lennon, LCSW
• Gina A Leno, PT
• Margaret Ann Lewandowski, FNP
• Karina Lopez
• M. M. Ahsan S.C. (Dr. Ahsan and Associates)
• Xiaoyu Ma
• Kelli Majka
• Catherine Malooly, MPT

• Optometrist in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.