Provider Demographics
NPI:1619180072
Name:JAN'S OPTICAL, LLC
Entity Type:Organization
Organization Name:JAN'S OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:HOUCK
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-2801
Mailing Address - Street 1:104 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4363
Mailing Address - Country:US
Mailing Address - Phone:318-255-2801
Mailing Address - Fax:318-255-2819
Practice Address - Street 1:104 N MONROE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4363
Practice Address - Country:US
Practice Address - Phone:318-255-2801
Practice Address - Fax:318-255-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161471Medicaid
LA4882200001Medicare ID - Type Unspecified