Provider Demographics
NPI:1154465151
Name:JEM OPTICAL INC
Entity Type:Organization
Organization Name:JEM OPTICAL INC
Other - Org Name:PEARLE VISION EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-457-2292
Mailing Address - Street 1:4259 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-1212
Mailing Address - Country:US
Mailing Address - Phone:708-457-2292
Mailing Address - Fax:708-457-1085
Practice Address - Street 1:4259 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-1212
Practice Address - Country:US
Practice Address - Phone:708-457-2292
Practice Address - Fax:708-457-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty