Jeanette Jezick, OD
Individual provider Active NPI Optometrist · Gales Ferry, CT
NPI 1922019918 · NPPES record last updated Aug 11, 2009
Key facts
- NPI
- 1922019918
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 002353 (CT)
- Practice address
- 1663 Route 12
Gales Ferry, CT 06335-1500 - Phone
- (860) 464-1040
- Fax
- (860) 464-1044
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- New England College of Optometry, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1663 Route 12
Gales Ferry, CT 06335-1500
Phone (860) 464-1040
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080429000189 | CT | Practitioner - Optometry | 7416035654 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002353 | CT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Jeanette Jezick OD., LLC | Optometrist | Current |
Accepting new patients |
Locations
1663 Route 12
Gales Ferry, CT 06335
Phone (860) 415-6049
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 002353 | CT | Yes |
Addresses
Primary practice location
1663 Route 12
Gales Ferry, CT 06335-1500
Mailing address
1663 Route 12
PO Box 421
Gales Ferry, CT 06335-1500
Phone (860) 464-1040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004132429 | Medicaid | CT |
Other providers in Gales Ferry, CT
- Holistic Mental Wellness Therapy
- Phyllis A. Holtzman
- Nicholas Houghton
- Naomi Hutchins
- Sarah Hafeez Ilahi
- Barbara Kidala
- Meghan E Lamoureux
- Lissette Larue
- Foong-Yi Lin
- Lindsay D Damato
All providers in Gales Ferry, CT · Optometrist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.