MEDICARE: DR. JOHN EMMERT 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	:	1730189754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EMMERT O.D.

Provider Business Mailing Address
First Line	:	2918 E 1979TH RD
Second Line	:
City	:	MARSEILLES
State	:	IL
Zip	:	61341-9308
Country	:	US
Telephone Number	:	815-434-2883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 LA SALLE ST
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-2018
Country	:	US
Telephone Number	:	815-433-4100
Fax Number	:

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/23/2007

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Directions to “ DR. JOHN EMMERT O.D.” Practice Location

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