Provider Demographics
NPI:1871262477
Name:JC VISION INC
Entity Type:Organization
Organization Name:JC VISION INC
Other - Org Name:ROCKFORD OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANTHALANGSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-997-0164
Mailing Address - Street 1:1592 HUNTING HOUND LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1855
Mailing Address - Country:US
Mailing Address - Phone:815-997-0164
Mailing Address - Fax:
Practice Address - Street 1:6560 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2545
Practice Address - Country:US
Practice Address - Phone:815-227-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty