Micetich, Jonathan Edward

Micetich, Jonathan Edward is an sole proprietor health care provider with primary practice located at 20 E North Street , Coal City IL 60416-1087. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Micetich, Jonathan Edward can be contacted via phone (815) 634-4825.

Contact Information

Primary practice address
20 E North Street Coal City IL 60416-1087
Phone: (815) 634-4825
Fax: (815) 634-4938
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046008925 Illinois

Profile Details

NPI number 1740273754
LBN Legal business name Micetich, Jonathan Edward
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 24th, 2005
Last updated Mar 25th, 2021 - about 4 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 1740273754 NPPES
Illinois MEDICAID 046008925
Illinois Other 3232003
Illinois Other 5075840001

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