Jennifer M Waller (NPI# 1861440612, PAC ID# 7618955154) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPTOMETRY.
| Nation Provider ID (NPI) | 1861440612 |
| PAC ID by PECOS | 7618955154 |
| Professional Enrollment ID | I20040710000271 |
| Full Name | Jennifer M Waller |
| Organization Legal Name | PRAIRIE EYE CENTER, LTD |
| Address |
130 W Ctr St Girard IL 62640-1222 |
| Phone Number | 2176272718 |
| Gender | F |
| Credential | OD |
| Medical School | UNIVERSITY OF MISSOURI ST LOUIS - SCHOOL OF OPTOMETRY |
| Graduation Year | 1998 |
| Primary Specialty | OPTOMETRY |
| Group Practice PAC ID | 6507779824 |
| Number of Group Practice Members | 18 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 130 W Ctr St, Girard, IL 62640-1222 | 2176272718 | PRAIRIE EYE CENTER, LTD |
| 2020 W Iles Ave, Springfield, IL 62704-4174 | 2176983030 | PRAIRIE EYE CENTER, LTD |
| Organization Legal Name | PRAIRIE EYE CENTER, LTD |
| Physicians | 20 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kaylyn Marie Nickelson | Optometry | Prairie Eye Center, Ltd | 518 Broadway St, Lincoln, IL 62656-2706 |
| Monica Ryan | Optometry | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Brian M Moore | Optometry | Prairie Eye Center, Ltd | 200 E Mechanic, Hillsboro, IL 62049-2007 |
| Emily Marie Beyer | Optometry | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Anne P Rowland | Ophthalmology | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Chelsey M Moore | Optometry | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Tyson J Herrmann | Optometry | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Mohamed G Gendy | Ophthalmology | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Fahad Habib Khan | Ophthalmology | Prairie Eye Center, Ltd | 2020 W Iles Ave, Springfield, IL 62704-4174 |
| Elizabeth R Heideman | Optometry | Prairie Eye Center, Ltd | 106 E Main St, Beardstown, IL 62618-1241 |
| Street Address |
130 W CTR ST |
| City | GIRARD |
| State | IL |
| Zip | 62640-1222 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Todd H Babcock | Chiropractic | 115 S 2nd St, Girard, IL 62640-1608 |
| City | GIRARD |
| Zip Code | 62640 |
| Specialty | OPTOMETRY |
| City + Specialty | GIRARD + OPTOMETRY |
Please comment or provide details below to improve the information on Jennifer M Waller.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.