Provider Demographics
NPI:1134631674
Name:J2LB LLC
Entity type:Organization
Organization Name:J2LB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-310-6973
Mailing Address - Street 1:702 N MIDVALE BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3261
Mailing Address - Country:US
Mailing Address - Phone:608-231-3937
Mailing Address - Fax:
Practice Address - Street 1:562 N MIDVALE BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3238
Practice Address - Country:US
Practice Address - Phone:608-231-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty