DR. JAY CHARLES BLACK (NPI# 1629113261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629113261 |
| Entity Type | Individual |
| Full Name | DR. JAY CHARLES BLACK |
| Credential | OD |
| Practice Address |
5316 N Second Street Loves Park IL 61111-5009 |
| Practice Telephone | 8158776551 |
| Practice Fax Number | 8158774821 |
| Mailing Telephone | 8158776551 |
| Mailing Fax Number | 8158774821 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 466709 | IL | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | FED ID NUMBER | 362871342 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942273396 | Jay A Black | Dentist | 315 Mchugh Blvd, 2d Den Bn/ndc, Camp Lejeune, NC 28547-2511 | 2006-02-08 |
| Street Address |
5316 N SECOND STREET |
| City | LOVES PARK |
| State | IL |
| Zip Code | 61111-5009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316562788 | Salli Jacobsen | Technician | 6699 Torch Lite Tr, Loves Park, IL 61111 | 2020-06-11 |
| 1003476425 | Costco Wholesale Corporation | Pharmacy | 5000 Stadium Drive, Loves Park, IL 61111 | 2019-06-18 |
| 1427541077 | Ronit Golan | Physical Therapist | 4401 Peak Dr Ste 1, Loves Park, IL 61111 | 2018-06-08 |
| 1598049025 | Sara Debelak | Developmental Therapist | 7225 Golden Eagle Drive, Loves Park, IL 61111 | 2011-10-03 |
| 1083906382 | Gagandeep Goyal | Anesthesiology | 5504 N 2nd St, Loves Park, IL 61111 | 2011-05-05 |
| 1124354261 | Asap Transport, LLC | Taxi | 7117 Clinton Rd, Suite 4, Loves Park, IL 61111 | 2009-10-25 |
| 1235212275 | Roger H Hill | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111 | 2006-10-23 |
| 1831104546 | Pointcore, Inc. | Pharmacy | 9951 Rock Cut Crossing, Loves Park, IL 61111 | 2006-07-30 |
| 1629099627 | Lisa A. Breisch | Counselor | Harmony Center for Holistic Psychotherapy, 6625 N. 2nd Street, Loves Park, IL 61111 | 2006-07-22 |
| 1386670529 | Joseph L Digirolamo | Chiropractor | 116 East Riverside Blvd, Loves Park, IL 61111 | 2006-06-22 |
| Find all providers in zip 61111 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740617570 | Eric Marnul | Optometrist | 5000 Stadium Dr, Loves Park, IL 61111-2301 | 2013-10-11 |
| 1225207558 | Jeffrey Allan Dannatt | Optometrist | 5020 N 2nd St, Loves Park, IL 61111-5809 | 2008-02-20 |
| 1235212275 | Roger H Hill | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111 | 2006-10-23 |
| 1043260144 | Donald E Wight | Optometrist | 6256 E Riverside Blvd, Loves Park, IL 61111-4418 | 2006-05-11 |
| 1427674811 | Eric Marnul Optometry Inc | Optometrist | 5000 Stadium Dr, Loves Park, IL 61111-2301 | 2020-06-22 |
| 1861048936 | Krupa V Patel | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111-6955 | 2019-08-14 |
| 1073002838 | Lucem LLC | Optometrist | 6256 E Riverside Blvd, Loves Park, IL 61111-4418 | 2018-05-08 |
| 1073015434 | Rockford Eye & Laser Center Ltd. | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111-6955 | 2018-03-01 |
| 1851899686 | Dekalb Eye Consultants, LLC | Optometrist | 4105 N Perryville Rd, Loves Park, IL 61111-8653 | 2018-01-26 |
| 1821450081 | Jeffrey Dannatt Ltd | Optometrist | 5020 N 2nd St, Loves Park, IL 61111-5809 | 2016-03-25 |
| Find all providers in LOVES PARK | ||||
| City | LOVES PARK |
| Zip Code | 61111 |
Please comment or provide details below to improve the information on DR. JAY CHARLES BLACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.