Provider Demographics
NPI:1972862670
Name:JONI'S OPTICAL
Entity Type:Organization
Organization Name:JONI'S OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-465-3116
Mailing Address - Street 1:615 S.MAIN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1747
Mailing Address - Country:US
Mailing Address - Phone:319-465-3116
Mailing Address - Fax:319-465-3116
Practice Address - Street 1:615 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1747
Practice Address - Country:US
Practice Address - Phone:319-465-3116
Practice Address - Fax:319-465-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA153007669332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAJEOPTICALMedicaid