Provider Demographics
NPI:1073854212
Name:KEM - JIREH OPTICAL
Entity Type:Organization
Organization Name:KEM - JIREH OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCIADO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICENCIADO
Authorized Official - Phone:787-364-7731
Mailing Address - Street 1:CALLE ORQUIDEA #60A BZN 671
Mailing Address - Street 2:BUENA VENTURA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8200
Mailing Address - Country:US
Mailing Address - Phone:787-364-7761
Mailing Address - Fax:787-655-4656
Practice Address - Street 1:CARR 195 KM 4.5 BO CAMPO RICO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-364-7761
Practice Address - Fax:787-655-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
586156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty