Waller, Jennifer

Waller, Jennifer is an individual health care provider with primary practice located at 2020 W Iles Ave , Springfield IL 62704-4174. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Waller, Jennifer can be contacted via phone (217) 698-3030.

Contact Information

Primary practice address
2020 W Iles Ave Springfield IL 62704-4174
Phone: (217) 698-3030
Fax: (217) 698-3068
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046009087 Illinois

Profile Details

NPI number 1861440612
LBN Legal business name Waller, Jennifer
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Feb 3rd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861440612 NPPES
Illinois Other 410038558 RAILROAD MEDICARE - GRD
Illinois MEDICAID 046009087 RAILROAD MEDICARE - GRD
Illinois Other 410038559 RAILROAD MEDICARE - GRD

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