Jonathan Edward Micetich, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008925 Issued in IL

Practice address

20 E North Street
Coal City, IL 60416-1087

Phone

(815) 634-4825

Fax

(815) 634-4938

NPI assigned

Aug 24, 2005

Last updated

Mar 25, 2021By 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

Other identifiers 3

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Illinois LLCGroup PAC ID 3577869965, 66 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmicetich020305@myeyedr.emadirect.md

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.

• Myeyedr Optometry of Illinois, LLC

  dba MyEyeDr.

  • Optometrist
  • Chicago, IL
  • NPI 1245695378
  Medicare reassignment Care Compare group NPD
• J. Micetich, OD & Associates Family Eye Care Center P C

  • Optometrist
  • Coal City, IL
  • NPI 1093832008
  Authorized official Same address or phone
• Myeyedr Optometry of Illinois, LLC

  • Optometrist
  • Chicago, IL
  • NPI 1154297752
  NPD
• Myeyedr Optometry of Illinois, LLC

  dba MyEyeDr.

  • Optometrist
  • Vernon Hills, IL
  • NPI 1679938575
  NPD
• Myeyedr Optometry of Illinois, LLC

  dba MyEyeDr.

  • Optometrist
  • Evanston, IL
  • NPI 1396100434
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1740273754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E NORTH STREET",
            "city": "COAL CITY",
            "state": "IL",
            "postal_code": "604161087",
            "telephone_number": "815-634-4825",
            "fax_number": "815-634-4938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICETICH",
        "first_name": "JONATHAN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008925",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "3232003",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL GOVERMENT SERVICES",
            "identifier": "5075840001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander J Linko, DPT
• Haley M Lockhart, LAT, ATC, MS
• Margaret Marsaglia
• Kassandra Lynn Marsala
• Shannon Masters
• Juli Weber Micetich, D.C.
• McKenzie Mieszkowski, LCPC, CADC
• Amber Megan Mitchell
• Monica Molesky
• Makayla Mulcahy, LCPC

• Optometrist in Coal City, IL
• Providers in Coal City, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.