Provider Demographics
NPI:1497179840
Name:JJ'S OPTICAL
Entity Type:Organization
Organization Name:JJ'S OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JAMELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-781-9151
Mailing Address - Street 1:3601 S CLARKSON ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3944
Mailing Address - Country:US
Mailing Address - Phone:303-781-9151
Mailing Address - Fax:303-781-1343
Practice Address - Street 1:3601 S CLARKSON ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3944
Practice Address - Country:US
Practice Address - Phone:303-781-9151
Practice Address - Fax:303-781-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherTAX IDENTIFICATION