Jon W Russell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008174 Issued in IL

Practice address

205 N State St
Marengo, IL 60152-2239

Phone

(815) 568-6508

NPI assigned

Jan 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marengo Vision Center, P.C.

  dba Harvard Family Eye Care

  • Optometrist
  • Harvard, IL
  • NPI 1396940938
  Medicare reassignment NPD
• Marengo Vision Center, P.C.

  • Optometrist
  • Marengo, IL
  • NPI 1992736276
  NPD
• Marengo Vision Center, P.C.

  • Optometrist
  • Johnsburg, IL
  • NPI 1477804912
  NPD (past)

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831177088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N STATE ST",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601522239",
            "telephone_number": "815-568-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N STATE ST",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601522239",
            "telephone_number": "815-568-6508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JON",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008174",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaya Pudlo
• Quality Renal Care LLC
• Erin Michelle Randall, MS,
• Riley Community Cons School Dist #18
• Javier Ramiro Rodriguez, OD
• Saint Anthony Medical Center (OSFMG - Marengo Clinic)
• Janelle Jean Schultz, M.A., CCC-SLP/L
• Janet Schultz
• Elizabeth E Siegfort, M.S., CCC/SLP/L
• Manfred Strohschein

• Optometrist in Marengo, IL
• Providers in Marengo, 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.
• 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.