Jacqueline Elaine Bullard, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

064011144 Issued in IL

Practice address

22 N Jackson St
Belleville, IL 62220-1425

Phone

(618) 233-1270

Fax

(618) 233-5939

NPI assigned

Aug 14, 2017

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

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

Indiana University - School of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Eye Care Solutions LTDGroup PAC ID 9234186628, 2 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 and National Provider Directory roles.

• Innovative Eye Care Solutions, LTD.

  dba Belleville Optometrists, Ltd.

  • Optometrist
  • Belleville, IL
  • NPI 1811088404
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1502668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1962927764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 N JACKSON ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201425",
            "telephone_number": "618-233-1270",
            "fax_number": "618-233-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 N JACKSON ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201425",
            "telephone_number": "618-233-1270",
            "fax_number": "618-233-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "JACQUELINE",
        "middle_name": "ELAINE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-14",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "064011144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucas Kyle Buckley, MD
• Yaimet Vidal Bucknor, MD
• Bradley Joseph Budde, MD
• Mary Buehler
• Mary Buehne, OTR/L
• Kayla Jean Bumpus, PT, DPT
• Stephen K. Burger, M. D.
• Patricia Burhanna, ANP, RN
• Macy Alexandra Burk, COTA/L
• Michelle M Burk, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; 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.