MEDICARE: DR. JILL SUZANNE DAVIDS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1023078961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL SUZANNE DAVIDS O.D.

Provider Business Mailing Address
First Line	:	1080 E EXCHANGE ST
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-3454
Country	:	US
Telephone Number	:	708-672-3937
Fax Number	:	708-672-3940

Provider Business Practice Location Address
First Line	:	1080 E EXCHANGE ST
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-3454
Country	:	US
Telephone Number	:	708-672-3937
Fax Number	:	708-672-3940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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