Provider Demographics
NPI:1417195199
Name:JAYEM OPTICIANS INC.
Entity Type:Organization
Organization Name:JAYEM OPTICIANS INC.
Other - Org Name:DBA WALTHAM COMMUNITY OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:781-894-0081
Mailing Address - Street 1:362 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5204
Mailing Address - Country:US
Mailing Address - Phone:781-894-0081
Mailing Address - Fax:
Practice Address - Street 1:362 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5204
Practice Address - Country:US
Practice Address - Phone:781-894-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1859156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1524518Medicaid
MA1524518Medicaid