Provider Demographics
NPI:1841314846
Name:JERSEY FAMILY VISION CARE, LTD
Entity type:Organization
Organization Name:JERSEY FAMILY VISION CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEINHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FCOVD
Authorized Official - Phone:618-498-7581
Mailing Address - Street 1:1600 S STATE ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-3620
Mailing Address - Country:US
Mailing Address - Phone:618-498-7581
Mailing Address - Fax:618-498-7586
Practice Address - Street 1:1600 S STATE ST
Practice Address - Street 2:SUITE I
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-3620
Practice Address - Country:US
Practice Address - Phone:618-498-7581
Practice Address - Fax:618-498-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00087102Medicare ID - Type UnspecifiedRAILROAD PROVIDER ID
ILU88149Medicare UPIN
IL206681Medicare PIN