Provider Demographics
NPI:1821087388
Name:J.E.D.INC
Entity Type:Organization
Organization Name:J.E.D.INC
Other - Org Name:VISION CARE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-848-4614
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0374
Mailing Address - Country:US
Mailing Address - Phone:787-848-4614
Mailing Address - Fax:787-848-4614
Practice Address - Street 1:396 ZONA IND REPARADA 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2347
Practice Address - Country:US
Practice Address - Phone:787-848-4614
Practice Address - Fax:787-848-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR511156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty