Provider Demographics
NPI:1427231968
Name:JJAL PS
Entity Type:Organization
Organization Name:JJAL PS
Other - Org Name:DOWNTOWN VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MCDOWALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-627-8711
Mailing Address - Street 1:766 ST HELENS AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3706
Mailing Address - Country:US
Mailing Address - Phone:253-627-8711
Mailing Address - Fax:253-627-1104
Practice Address - Street 1:766 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3706
Practice Address - Country:US
Practice Address - Phone:253-627-8711
Practice Address - Fax:253-627-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029841Medicaid
WA2029841Medicaid
WAG8853496Medicare PIN
WA5762550001Medicare NSC