Provider Demographics
NPI:1891953501
Name:CATES, JACK ELLIS (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:ELLIS
Last Name:CATES
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6242
Mailing Address - Street 2:1737 WEST 3RD ST
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-264-6917
Mailing Address - Fax:334-262-9230
Practice Address - Street 1:1737 WEST 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-264-6917
Practice Address - Fax:334-262-9230
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician