Provider Demographics
NPI:1083894323
Name:JCA OPTICAL
Entity Type:Organization
Organization Name:JCA OPTICAL
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALGIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-727-7777
Mailing Address - Street 1:1053 ROUTE 58
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2019
Mailing Address - Country:US
Mailing Address - Phone:631-727-7777
Mailing Address - Fax:631-727-7822
Practice Address - Street 1:1053 ROUTE 58
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2019
Practice Address - Country:US
Practice Address - Phone:631-727-7777
Practice Address - Fax:631-727-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003078332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0349630001Medicare NSC