Provider Demographics
NPI:1376739649
Name:B & J OPTICAL
Entity Type:Organization
Organization Name:B & J OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-852-0662
Mailing Address - Street 1:16 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1211
Mailing Address - Country:US
Mailing Address - Phone:740-852-0662
Mailing Address - Fax:740-852-0668
Practice Address - Street 1:16 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1211
Practice Address - Country:US
Practice Address - Phone:740-852-0662
Practice Address - Fax:740-852-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0613929Medicaid
OH9264901Medicare PIN
OH0613929Medicaid