Provider Demographics
NPI:1538686605
Name:JK OPTICAL INC.
Entity Type:Organization
Organization Name:JK OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:KYRIAM
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICO
Authorized Official - Phone:787-201-0524
Mailing Address - Street 1:HC 1 BOX 167691
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9073
Mailing Address - Country:US
Mailing Address - Phone:787-201-0524
Mailing Address - Fax:
Practice Address - Street 1:3 CARR CENTRO COMERCIAL SAN JOSE LOCAL #13
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty