Provider Demographics
NPI:1871552174
Name:FRANK, JEFF BRIAN (OD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:BRIAN
Last Name:FRANK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3109
Mailing Address - Country:US
Mailing Address - Phone:773-636-5363
Mailing Address - Fax:
Practice Address - Street 1:2570 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3109
Practice Address - Country:US
Practice Address - Phone:815-758-1039
Practice Address - Fax:815-756-1396
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009566Medicaid
IL046009566Medicaid
P00755832Medicare PIN
ILK05847Medicare PIN