Provider Demographics
NPI:1629677638
Name:JICHA VISION OPTOMETRY PLLC
Entity Type:Organization
Organization Name:JICHA VISION OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:POPA
Authorized Official - Last Name:JICHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-688-5604
Mailing Address - Street 1:2607 BURCH PT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9333
Mailing Address - Country:US
Mailing Address - Phone:336-688-5604
Mailing Address - Fax:
Practice Address - Street 1:1226 E DIXIE DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8856
Practice Address - Country:US
Practice Address - Phone:336-626-2458
Practice Address - Fax:336-625-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty