Provider Demographics
NPI:1578783288
Name:JENA INC
Entity Type:Organization
Organization Name:JENA INC
Other - Org Name:LIFESTYLE EYECARE & MILLIS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINDNESS
Authorized Official - Suffix:
Authorized Official - Credentials:ROD
Authorized Official - Phone:508-376-0800
Mailing Address - Street 1:18 MILLISTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1600
Mailing Address - Country:US
Mailing Address - Phone:508-376-0800
Mailing Address - Fax:508-376-2539
Practice Address - Street 1:18 MILLISTON ROAD
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1600
Practice Address - Country:US
Practice Address - Phone:508-376-0800
Practice Address - Fax:508-376-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMASS 1954156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1533622Medicaid