Lake Bluff Family Eye Care, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008452 Issued in IL

Legal business name

LAKE BLUFF FAMILY EYE CARE, INC.

Practice address

755 Rockland Road
Suite 201
Lake Bluff, IL 60044

Phone

(847) 735-1699

NPI assigned

Mar 7, 2013

Organization subpart

No

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

Authorized official

Name

Dr. David Jackson, O.D.

Title

President

Phone

(847) 735-1699

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1821339482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 ROCKLAND ROAD",
            "address_2": "SUITE 201",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "60044",
            "telephone_number": "847-735-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 ROCKLAND ROAD",
            "address_2": "SUITE 201",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "60044",
            "telephone_number": "847-735-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE BLUFF FAMILY EYE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-07",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-735-1699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS OPTOMETRIST PROFESSIONAL LICENSE",
            "identifier": "046008452",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Hayley Lakin

• Optometrist in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.