Provider Demographics
NPI:1992189757
Name:TJK VISION LLC
Entity Type:Organization
Organization Name:TJK VISION LLC
Other - Org Name:VISION SOURCE CARLSBAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-251-8669
Mailing Address - Street 1:201 W FOX ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5736
Mailing Address - Country:US
Mailing Address - Phone:575-885-3937
Mailing Address - Fax:575-885-1178
Practice Address - Street 1:201 W FOX ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5736
Practice Address - Country:US
Practice Address - Phone:575-885-3937
Practice Address - Fax:575-885-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty