Provider Demographics
NPI:1073989810
Name:JCM EEUU CORPORATION
Entity Type:Organization
Organization Name:JCM EEUU CORPORATION
Other - Org Name:JCM OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOLFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-391-1136
Mailing Address - Street 1:9467 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2010
Mailing Address - Country:US
Mailing Address - Phone:786-391-1136
Mailing Address - Fax:
Practice Address - Street 1:9467 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2010
Practice Address - Country:US
Practice Address - Phone:786-391-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty