Provider Demographics
NPI:1669032538
Name:JAHRLING OCULAR PROSTHETICS INC.
Entity Type:Organization
Organization Name:JAHRLING OCULAR PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAHRLING
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:617-523-2280
Mailing Address - Street 1:50 STANIFORD ST 8TH FLR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2562
Mailing Address - Country:US
Mailing Address - Phone:617-523-2280
Mailing Address - Fax:617-523-8602
Practice Address - Street 1:120 DUDLEY STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2429
Practice Address - Country:US
Practice Address - Phone:401-454-4168
Practice Address - Fax:401-454-4781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAHRLING OCULAR PROSTHETICS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJP00706Medicaid