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

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 and National Provider Directory roles.

• Ziva Optical II, LTD.

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

  • 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.
• 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.