Jack B Vontillius, OD is a medicare enrolled "Optometrist" provider in Soddy Daisy, Tennessee. His current practice location is
9453 Dayton Pike, Soddy Daisy, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(423) 332-8222.
Jack B Vontillius is licensed to practice in Tennessee (license number OD0000002781) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1194906883.
Healthcare Provider's Profile
| Full Name | Jack B Vontillius |
|---|
| Gender | Male |
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| Speciality | Optometrist |
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| Location | 9453 Dayton Pike, Soddy Daisy, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1194906883
- Provider Enumeration Date: 11/21/2007
- Last Update Date: 06/27/2013
Medicare PECOS Information:
- PECOS PAC ID: 9931289535
- Enrollment ID: I20090624000305
Medical Identifiers
Medical identifiers for Jack B Vontillius such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194906883 | NPI | - | NPPES |
| 1515043 | Medicaid | TN | |
| 4230667 | Other | TN | BCBS OF TN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | TUV007223 (New York) | Secondary |
| 152W00000X | Optometrist | OD0000002781 (Tennessee) | Primary |
| 152W00000X | Optometrist | OP002631 (Georgia) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack B Vontillius is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jack B Vontillius, OD
9453 Dayton Pike,
Soddy Daisy, TN 37379-4751
Ph: (423) 332-8222 | Jack B Vontillius, OD
9453 Dayton Pike,
Soddy Daisy, TN 37379-4751
Ph: (423) 332-8222 |
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