Provider Demographics
NPI:1275965378
Name:JURY EYE CARE LLC
Entity Type:Organization
Organization Name:JURY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:JURY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-247-6515
Mailing Address - Street 1:926 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3510
Mailing Address - Country:US
Mailing Address - Phone:316-247-6515
Mailing Address - Fax:678-928-0651
Practice Address - Street 1:926 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3510
Practice Address - Country:US
Practice Address - Phone:316-247-6515
Practice Address - Fax:678-928-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1282-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200622550AMedicaid
6541290001Medicare NSC
KS1465Medicare PIN