Provider Demographics
NPI:1275827107
Name:JAJ EYEWEAR INC.
Entity Type:Organization
Organization Name:JAJ EYEWEAR INC.
Other - Org Name:EYES OF MENDOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELAINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-686-9393
Mailing Address - Street 1:740 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3762
Mailing Address - Country:US
Mailing Address - Phone:651-686-9393
Mailing Address - Fax:651-556-2568
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-3762
Practice Address - Country:US
Practice Address - Phone:651-686-9393
Practice Address - Fax:651-556-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty