=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972708626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JILL A. SETTERLUN, O.D., LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8826 OGDEN AVE
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60513-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-485-0411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8826 OGDEN AVE
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60513-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-485-0411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JILL ANNE SETTERLUN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 708-485-0411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------