Provider Demographics
NPI:1891781647
Name:AJOPTICAL, LLC
Entity Type:Organization
Organization Name:AJOPTICAL, LLC
Other - Org Name:CUNNINGHAM OPTICAL ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNET
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-289-4475
Mailing Address - Street 1:1608 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2205
Mailing Address - Country:US
Mailing Address - Phone:765-289-4475
Mailing Address - Fax:765-284-2806
Practice Address - Street 1:1608 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2205
Practice Address - Country:US
Practice Address - Phone:765-289-4475
Practice Address - Fax:765-284-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100150920AMedicaid
IN100150920AMedicaid