Provider Demographics
NPI:1912397571
Name:JEMM OPTICAL BOUTIQUE LLC
Entity Type:Organization
Organization Name:JEMM OPTICAL BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PORSHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-866-9000
Mailing Address - Street 1:26 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2267
Mailing Address - Country:US
Mailing Address - Phone:732-866-9000
Mailing Address - Fax:
Practice Address - Street 1:26 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2267
Practice Address - Country:US
Practice Address - Phone:732-866-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty