Joseph Barry Jackson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

46007341 Issued in IL

Practice address

3323 Frontage Rd
Peru, IL 61354-1101

Phone

(815) 220-0652

Fax

(815) 220-0732

NPI assigned

Oct 19, 2006

Last updated

Jan 8, 2014By 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

Other identifiers 2

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, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J a K Enterprises IncGroup PAC ID 3173519014, 24 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J a K Enterprises Inc

  dba Bard Optical

  • Eyewear Supplier
  • Peoria, IL
  • NPI 1508856923

  Optometrist

  Medicare reassignment Care Compare group NPD
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Litchfield, IL
  • NPI 1205663499

  Optometrist

  NPD
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Galesburg, IL
  • NPI 1033163282

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Canton, IL
  • NPI 1124072269

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Pekin, IL
  • NPI 1164476354

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • East Peoria, IL
  • NPI 1528012218

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1548629256

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Washington, IL
  • NPI 1588603138

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Moline, IL
  • NPI 1790723542

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Quincy, IL
  • NPI 1851163182

  Optometrist

  NPD (past)
• J a K Enterprises Inc

  dba Bard Optical

  • Durable Medical Equipment & Medical Supplies
  • Normal, IL
  • NPI 1932153186

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389139200000",
    "number": "1649352691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8309 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152170",
            "telephone_number": "309-693-9540",
            "fax_number": "309-693-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3323 FRONTAGE RD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541101",
            "telephone_number": "815-220-0652",
            "fax_number": "815-220-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "BARRY",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2014-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46007341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7215175",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG4165",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Curtis Roy Imel, DDS PC
• Independent for Life, Inc.
• Kleven H Israelsen, D.O.
• J a K Enterprises Inc (Bard Optical)
• Alisha Jackson, FNP
• Elizabeth Sue Jennings-Porter, CNM
• Jacob Joachim, PHARMD
• Joel S. Leifheit M.D., P.C.
• Karissa Lee Johnson, RPH
• Lisa Kelly Jones

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.