Mary Jacobson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

46008491 Issued in IL

Practice address

307 Golf Mill Ctr
Niles, IL 60714-1217

Phone

(847) 803-1770

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Uy Other name

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Luxottica of America Inc.

  • Point of Service
  • Mason, OH
  • NPI 1831244953

  IL

  Medicare reassignment
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790833549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 N ROYAL BIRKDALE DR",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600614572",
            "telephone_number": "312-320-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 GOLF MILL CTR",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607141217",
            "telephone_number": "847-803-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MARY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46008491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "UY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Integrative Health & Behavioral Wellness
• Iris & Co Inc
• Isaac Parampottil Isaac, DDS
• Michelle Melissa Ishaya, DO
• Jibin Jacob, PHARM.D
• Jalal Rais Dana MD LTD
• Jamie Y. Park, D.D.S., LTD
• Jane Kim LCSW, LLC
• Katherine Janezic, NP
• Renata Maria Jankowska, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.