Provider Demographics
NPI:1588767024
Name:JURKOVIC, MICHELE A (OD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:JURKOVIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3117
Mailing Address - Country:US
Mailing Address - Phone:815-758-2020
Mailing Address - Fax:815-756-8843
Practice Address - Street 1:2810 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3117
Practice Address - Country:US
Practice Address - Phone:815-758-2020
Practice Address - Fax:815-756-8843
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01925837OtherBCBS
IL553710Medicare PIN
01925837OtherBCBS