Provider Demographics
NPI:1225743677
Name:JIREH EYE CARE LLC
Entity Type:Organization
Organization Name:JIREH EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-607-2682
Mailing Address - Street 1:7914 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1124
Mailing Address - Country:US
Mailing Address - Phone:917-607-2682
Mailing Address - Fax:718-641-3792
Practice Address - Street 1:11110 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1898
Practice Address - Country:US
Practice Address - Phone:718-641-3450
Practice Address - Fax:718-641-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602862Medicaid