Jennifer Waller, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009087 Issued in IL

Practice address

2020 W Iles Ave
Springfield, IL 62704-4174

Phone

(217) 698-3030

Fax

(217) 698-3068

NPI assigned

May 4, 2006

Last updated

Feb 3, 2023By the provider in NPPES

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 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

University of Missouri St Louis - School of Optometry, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Springfield Vision Care Associates LTDGroup PAC ID 3678586187, 9 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Springfield Vision Care Associates, LTD

  dba Vision Care Associates

  • Optometrist
  • Springfield, IL
  • NPI 1811935406
  Medicare reassignment Care Compare group NPD
• Fireside Eye Care, P.C.

  • Optometrist
  • Benld, IL
  • NPI 1447448717
  Medicare reassignment NPD
• JFJ Eyecare LTD

  dba Quantum Vision Centers

  • Optometrist
  • Swansea, IL
  • NPI 1295778587
  NPD (past)
• Prairie Eye Center LTD

  • Optometrist
  • Hillsboro, IL
  • NPI 1477783694
  NPD (past)
• Prairie Eye Center LTD

  • Optometrist
  • Girard, IL
  • NPI 1821228040
  NPD (past)
• Springfield Clinic, LLP

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1780638478
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1861440612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S 8TH ST",
            "city": "BENLD",
            "state": "IL",
            "postal_code": "620091446",
            "telephone_number": "217-835-7724",
            "fax_number": "217-835-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044174",
            "telephone_number": "217-698-3030",
            "fax_number": "217-698-3068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Benld",
            "state": "IL",
            "postal_code": "62009",
            "country_code": "US",
            "telephone_number": "217-835-7724",
            "fax_number": "217-835-7611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - GRD",
            "identifier": "410038558",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046009087",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - SPFLD",
            "identifier": "410038559",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jarrod C Wall, MD
• Stephanie Lynn Wall, COTA/L
• Kelsey A Wallace, CRNA
• Stephen E. Wallace, M.D.
• Shannon D Walle, FNP-BC
• Jamie Wallman, MD
• Katherine L Walls, P.A.-C.
• Lamar Walls
• Walmart Inc.
• Walmart Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; 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.