Individual provider Active NPI

Jennifer Cameron, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1750537072
Registry record updated Dec 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046010086 Issued in IL
Practice address
2110 W Roscoe St
Chicago, IL 60618-6387
Phone
(773) 975-2015
Fax
(773) 975-2476
NPI assigned
Aug 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010086 IL Primary

Addresses

Primary practice location

2110 W Roscoe St
Chicago, IL 60618-6387

Mailing address

2110 W Roscoe St
Chicago, IL 60618-6387
Phone (773) 975-2015

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130312000075 IL Order and Referring Only - OptometryPractitioner - Optometry 6608936893

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southport Eye Associates LTD Optometrist CurrentSince Aug 20, 2018 Accepting new patients
Visionworks, Inc Past Accepting new patients
Visionworks, Inc. Optometrist PastSince Mar 17, 2018 Accepting new patients

Locations

3123 N Broadway St
Chicago, IL 60657
Phone (773) 880-5400

3539 N Southport Ave
Unit North
Chicago, IL 60657
Phone (773) 975-2015

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418688000000",
    "number": "1750537072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 W ROSCOE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186387",
            "telephone_number": "773-975-2015",
            "fax_number": "773-975-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 W ROSCOE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186387",
            "telephone_number": "773-975-2015",
            "fax_number": "773-975-2476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMERON",
        "first_name": "JENNIFER",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2014-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.