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NPI Code Detail

MEDICARE: DR. JILL C INGELSE O.D.

MEDICARE: DR. JILL C INGELSE 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
1152WP0200XPediatric Optometrist046009096IL
2152W00000XOptometrist046009096IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21634291OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1528058443
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL C INGELSE O.D.
Provider Business Mailing Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-388-1228
Fax Number : 708-388-1696
Provider Business Practice Location Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-388-1228
Fax Number : 708-810-9726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2005
Last Update Date : 08/27/2024

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