Provider Demographics
NPI:1033326202
Name:J. PHILLIP JAROS O.D. & ASSOC
Entity Type:Organization
Organization Name:J. PHILLIP JAROS O.D. & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JAROS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-374-3335
Mailing Address - Street 1:411 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5448
Mailing Address - Country:US
Mailing Address - Phone:870-772-9558
Mailing Address - Fax:
Practice Address - Street 1:411 HICKORY ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5448
Practice Address - Country:US
Practice Address - Phone:870-772-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART86114Medicare UPIN