Jasper J Gulotta, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-7183 Issued in IL

Practice address

835 E 162ND St
South Holland, IL 60473-2465

Phone

(708) 333-4444

Fax

(708) 333-4454

NPI assigned

Aug 18, 2005

Last updated

Nov 15, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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.

• Advanced Eyecare South Holland OD and Associates PC

  dba Advanced Eyecare of South Holland

  • Optometrist
  • South Holland, IL
  • NPI 1942749791
  Medicare reassignment NPD
• Jasper Gulotta

  dba South Holland Optometric Associates

  • Optometrist
  • South Holland, IL
  • NPI 1497937403
  Authorized official Same address or phone

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1669464251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 E 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732465",
            "telephone_number": "708-333-4444",
            "fax_number": "708-333-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 E 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732465",
            "telephone_number": "708-333-4444",
            "fax_number": "708-333-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULOTTA",
        "first_name": "JASPER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-7183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Michael Gorman, D.D.S.
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• Richard Grevengoed, L.C.P.C.
• Aarti Gupta
• Beverly Hadley, D.D.S.
• Dana Hamilton
• Rhonda Hampton-Tolbert, CNA
• Lakeisha Hampton, LCSW

• Optometrist in South Holland, IL
• Providers in South Holland, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.