Provider Demographics
NPI:1417328444
Name:CJ OPTICAL HOLDINGS LLC
Entity Type:Organization
Organization Name:CJ OPTICAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-388-7550
Mailing Address - Street 1:13676 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1567
Mailing Address - Country:US
Mailing Address - Phone:305-388-7550
Mailing Address - Fax:
Practice Address - Street 1:13676 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1567
Practice Address - Country:US
Practice Address - Phone:305-388-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization