Healthcare Provider Details

I. General information

NPI: 1841314846
Provider Name (Legal Business Name): JERSEY FAMILY VISION CARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S STATE ST SUITE I
JERSEYVILLE IL
62052-3620
US

IV. Provider business mailing address

1600 S STATE ST SUITE I
JERSEYVILLE IL
62052-3620
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-7581
  • Fax: 618-498-7586
Mailing address:
  • Phone: 618-498-7581
  • Fax: 618-498-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE ANN STEINHAUER
Title or Position: PRESIDENT
Credential: OD, FCOVD
Phone: 618-498-7581