NORTHERN ILLINOIS OPTICAL CO INC (NPI# 1639252273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639252273 |
| Entity Type | Organization |
| Organization Name | NORTHERN ILLINOIS OPTICAL CO INC |
| Practice Address |
121 N Madison St Rockford IL 61107-3949 |
| Practice Telephone | 8159633454 |
| Practice Fax Number | 8159634384 |
| Mailing Telephone | 8159633454 |
| Mailing Fax Number | 8159634384 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-01-18 |
| Authorized Official Name | MICHAEL EARL FULLING (PRESIDENT) |
| Authorized Official Telephone | 8159633454 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 10115103 | 01 |
| Street Address |
121 N MADISON ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-3949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598834293 | Kenneth Ronald Minarik | Optometrist | 121 N Madison St, Rockford, IL 61107-3949 | 2006-11-07 |
| 1407925100 | Carl Michael Simone | Optometrist | 121 N Madison St, Rockford, IL 61107-3949 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639391832 | Jose L Nieves | Technician/Technologist | 4010 E State St Ste 103, Rockford, IL 61108-2044 | 2007-05-03 |
| 1497893598 | Wisconsin Vision, Inc | Technician/Technologist | 280 N Phelps Ave Unit A, Rockford, IL 61108-2498 | 2007-02-01 |
| 1528138757 | Catherine J Whalen | Technician/Technologist | 5970 E State St, Rockford, IL 61108-2430 | 2006-11-08 |
| 1184018848 | Usv Optical Inc. | Technician/Technologist | 2013 Mcfarland Rd, Rockford, IL 61107 | 2015-03-20 |
| 1295908341 | Patricia Ann Carpenter | Technician/Technologist | 130 N 1st St, Rockford, IL 61107-3900 | 2008-04-09 |
| 1821118399 | Linden Optical | Technician/Technologist | 1215 N Alpine Rd, Rockford, IL 61107-2201 | 2007-03-30 |
| 1063595643 | Wal-mart Stores, Inc | Technician/Technologist | 3902 W Riverside Blvd, Rockford, IL 61101-9507 | 2006-10-24 |
| 1750463675 | Wal-mart Stores, Inc | Technician/Technologist | 3849 Northridge Dr, Rockford, IL 61114-4773 | 2006-10-19 |
| 1013098151 | Wal-mart Stores, Inc | Technician/Technologist | 7219 Walton St, Rockford, IL 61108-2607 | 2006-10-17 |
| 1316048572 | Sam's Club Optical | Technician/Technologist | 7151 Walton St, Rockford, IL 61108-2600 | 2006-09-26 |
| Find all providers in ROCKFORD | ||||
Please comment or provide details below to improve the information on NORTHERN ILLINOIS OPTICAL CO INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.