MEDICARE: DR. JESSICA DIXON HEINKE 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	152WC0802X	Corneal and Contact Management Optometrist	3133-035	WI
2	152W00000X	Optometrist	3133-035	WI
3	152WP0200X	Pediatric Optometrist	046-009519	IL
4	152WP0200X	Pediatric Optometrist	3133-035	WI
5	152W00000X	Optometrist	046-009519	IL
6	152WC0802X	Corneal and Contact Management Optometrist	046-009519	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632090	OTHER	IL	IL BCBS
2	7333267	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1720089865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA DIXON HEINKE O.D.

Provider Business Mailing Address
First Line	:	233 WASHINGTON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3399
Country	:	US
Telephone Number	:	815-338-0674
Fax Number	:	815-338-6139

Provider Business Practice Location Address
First Line	:	233 WASHINGTON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3399
Country	:	US
Telephone Number	:	815-338-0674
Fax Number	:	815-338-6139

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/26/2026

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