Nicole C Sidock, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009589 Issued in IL

Practice address

4406 16TH St
Moline, IL 61265-7012

Phone

(309) 762-2020

Fax

(309) 762-2022

NPI assigned

Mar 1, 2007

Sex

Female

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, IA2 enrollments

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 2

Specialty

Optometry

Education

Indiana University - School of Optometry, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Vep Il Optometric LLCGroup PAC ID 3678814217, 27 clinicians

Augustin Eye Care PLCGroup PAC ID 1658503818, 3 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 and National Provider Directory roles.

• Vep Il Optometric LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1528536620
  Medicare reassignment Care Compare group NPD
• Augustin Eye Care PLC

  • Optometrist
  • Waterloo, IA
  • NPI 1881015311
  Medicare reassignment Care Compare group NPD
• Oneopto Il 2 PLLC

  • Optometrist
  • Bloomington, IL
  • NPI 1003788431
  NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274313600000",
    "number": "1700914504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4406 16TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657012",
            "telephone_number": "309-762-2020",
            "fax_number": "309-762-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4406 16TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657012",
            "telephone_number": "309-762-2020",
            "fax_number": "309-762-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDOCK",
        "first_name": "NICOLE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2010-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle R. Shepherd, PMHNP-BC
• Linda Kay Shields, CADC
• Justin Dwight Shoemaker, LCSW
• Kristin Marie Shumann, M.S.ED.
• Andrew Graham Sichling, LMSW
• Alan Howard Siegel, MD
• Silience Counseling Services, PLLC
• Desiree Diocson Simpao, PT
• Param Puneet Singh, M.D.
• Annette Zoe Sirek Jones, MS, CCC-SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.