Provider Demographics
NPI:1780875898
Name:BROCKMAN, JANNA F (OD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:F
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:F
Other - Last Name:LINDEMULDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JANNA JASPER OD
Mailing Address - Street 1:5985 LAKESIDE PL
Mailing Address - Street 2:UNIT 304
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1985
Mailing Address - Country:US
Mailing Address - Phone:708-614-0558
Mailing Address - Fax:
Practice Address - Street 1:255 LINCOLN MALL DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2328
Practice Address - Country:US
Practice Address - Phone:708-481-8722
Practice Address - Fax:708-481-8719
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist