Provider Demographics
NPI:1871653287
Name:J&R OPTICAL INC
Entity Type:Organization
Organization Name:J&R OPTICAL INC
Other - Org Name:ODOM'S OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:O
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:601-597-2366
Mailing Address - Street 1:PO BOX 18482
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8482
Mailing Address - Country:US
Mailing Address - Phone:601-597-2366
Mailing Address - Fax:601-445-2282
Practice Address - Street 1:118 LOWER WOODVILLE ROAD
Practice Address - Street 2:#19
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4451
Practice Address - Country:US
Practice Address - Phone:601-597-2366
Practice Address - Fax:601-445-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0880189Medicaid
MS0880189Medicaid