Healthcare Provider Details

I. General information

NPI: 1821196114
Provider Name (Legal Business Name): JEFFREY H. GETZELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 N. RIDGE AVE. STE. 100-B
EVANSTON IL
60201-5918
US

IV. Provider business mailing address

1740 N. RIDGE AVE. STE. 100-B
EVANSTON IL
60201-5918
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-9850
  • Fax: 847-866-9822
Mailing address:
  • Phone: 847-866-9850
  • Fax: 847-866-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: