Provider Demographics
NPI:1033394275
Name:J & SN PA
Entity Type:Organization
Organization Name:J & SN PA
Other - Org Name:VISION CENTER OF HEATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-772-7711
Mailing Address - Street 1:316 S GOLIAD ST
Mailing Address - Street 2:STE 205
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3760
Mailing Address - Country:US
Mailing Address - Phone:972-772-7711
Mailing Address - Fax:
Practice Address - Street 1:316 S GOLIAD ST STE 205
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3944
Practice Address - Country:US
Practice Address - Phone:972-772-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00412TMedicare PIN
TXX71430Medicare UPIN