Healthcare Provider Details

I. General information

NPI: 1699601062
Provider Name (Legal Business Name): JESSICA JANOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 GREEN BAY RD STE 165
HIGHLAND PARK IL
60035-3165
US

IV. Provider business mailing address

38 S WILDWOOD DR
PROSPECT HEIGHTS IL
60070-1141
US

V. Phone/Fax

Practice location:
  • Phone: 847-780-3806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012095
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: