Provider Demographics
NPI:1417008624
Name:JARTLL CORP
Entity Type:Organization
Organization Name:JARTLL CORP
Other - Org Name:ROLAND OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-871-1234
Mailing Address - Street 1:6523 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3066
Mailing Address - Country:US
Mailing Address - Phone:248-593-9955
Mailing Address - Fax:248-593-9966
Practice Address - Street 1:6523 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3066
Practice Address - Country:US
Practice Address - Phone:248-593-9955
Practice Address - Fax:248-593-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37720Medicare ID - Type Unspecified
MI0315500001Medicare NSC