Provider Demographics
NPI:1184404709
Name:9FIVERS LLC
Entity type:Organization
Organization Name:9FIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRADDUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-254-5523
Mailing Address - Street 1:2163 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2203
Mailing Address - Country:US
Mailing Address - Phone:619-482-9595
Mailing Address - Fax:
Practice Address - Street 1:2163 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2203
Practice Address - Country:US
Practice Address - Phone:619-482-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier