Colin N Jack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002034 Issued in IN

Practice address

2101 Burlington Beach Rd.
Suite D
Valparaiso, IN 46383-0000

Phone

(219) 462-0309

Fax

(219) 464-4291

NPI assigned

Feb 28, 2006

Last updated

Feb 4, 2015By 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 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Merit-based Incentive Payment System (MIPS)

Final score

71.74 of 100Reported as group

Quality

96.85

Improvement activities

40

Cost

10

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjack@ltfeyeclinics.direct.eyemdemr.com

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.

• Northwest Indiana Eye Associates, PC

  dba d/b/a Lewyckyj-Taglia- Felton Eye Clinics

  • Ophthalmology Physician
  • Valparaiso, IN
  • NPI 1336115237

  Optometrist

  Medicare reassignment NPD
• Northwest Indiana Eye Associates, PC

  dba d/b/a Lewyckyj-Taglia-Felton Eye Clinics

  • Ophthalmology Physician
  • Crown Point, IN
  • NPI 1992999106

  Optometrist

  NPD
• Northwest Indiana Eye Associates, PC

  dba d/b/a Lewyckyj-Taglia-Felton Eye Clinics

  • Ophthalmology Physician
  • Munster, IN
  • NPI 1861686099

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423008000000",
    "number": "1700853637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 BURLINGTON BEACH RD.",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463830000",
            "telephone_number": "219-462-0309",
            "fax_number": "219-464-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 BURLINGTON BEACH RD.",
            "address_2": "SUITE D",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463830000",
            "telephone_number": "219-462-0309",
            "fax_number": "219-464-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "COLIN",
        "middle_name": "N",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2015-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100208430B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Ison, BSW
• Regina S Isroff, R.D., L.D., C.D.
• Ivf Chicagoland, LTD
• Eric Izynski
• Ronald Edward Izynski I, DPM
• Jackie Gasparovic Corp.
• Nicole Toyi Jackson-Musenja, M.A.
• Dominique Jackson, LCSW
• Jacobs Ladder
• La Tanya L Jahan Robbins

• Optometrist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; 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.