Provider Demographics
NPI:1437329513
Name:JAMES OPTICAL INC.
Entity Type:Organization
Organization Name:JAMES OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICAN
Authorized Official - Prefix:
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FENNEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:419-693-3376
Mailing Address - Street 1:2737 NAVARRE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3276
Mailing Address - Country:US
Mailing Address - Phone:419-693-3376
Mailing Address - Fax:419-693-7519
Practice Address - Street 1:2737 NAVARRE AVE STE 204
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3276
Practice Address - Country:US
Practice Address - Phone:419-693-3376
Practice Address - Fax:419-693-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC 2077332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0511637Medicaid
10251OtherPARAMOUNT HEALTH CARE
OH0511637Medicaid