Provider Demographics
NPI:1255683801
Name:CHRIS ROLLINS & LAURA WILLIAMS PTRS
Entity Type:Organization
Organization Name:CHRIS ROLLINS & LAURA WILLIAMS PTRS
Other - Org Name:C&J OPTICAL FASHIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-384-1779
Mailing Address - Street 1:731 E YOSEMITE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8039
Mailing Address - Country:US
Mailing Address - Phone:209-384-1779
Mailing Address - Fax:209-384-1076
Practice Address - Street 1:731 E YOSEMITE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8039
Practice Address - Country:US
Practice Address - Phone:209-384-1779
Practice Address - Fax:209-384-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173598332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0768850001Medicare NSC