Provider Demographics
NPI:1447472931
Name:DR JURGENSEN & ASSOCIATES
Entity type:Organization
Organization Name:DR JURGENSEN & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:JURGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-629-3030
Mailing Address - Street 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3347
Mailing Address - Country:US
Mailing Address - Phone:630-629-3030
Mailing Address - Fax:630-629-1941
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3347
Practice Address - Country:US
Practice Address - Phone:630-629-3030
Practice Address - Fax:630-629-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4682990001Medicare NSC
IL569500Medicare PIN