Provider Demographics
NPI:1528375771
Name:JAAP INC
Entity Type:Organization
Organization Name:JAAP INC
Other - Org Name:CANDELA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:V
Authorized Official - Last Name:CANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-790-1849
Mailing Address - Street 1:4110 MOSEBY ST
Mailing Address - Street 2:MAIN EXCHANGE PX
Mailing Address - City:FORT JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207-0614
Mailing Address - Country:US
Mailing Address - Phone:803-790-1849
Mailing Address - Fax:803-790-1846
Practice Address - Street 1:4110 MOSEBY ST
Practice Address - Street 2:MAIN EXCHANGE PX
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-6118
Practice Address - Country:US
Practice Address - Phone:803-790-1849
Practice Address - Fax:803-790-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO7957Medicaid
SCDO7957Medicaid
SCU40847Medicare UPIN
SCU408475531Medicare PIN
SCU408476691Medicare PIN