Provider Demographics
NPI:1396897146
Name:JULES OPTICAL CO, LTD
Entity type:Organization
Organization Name:JULES OPTICAL CO, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSSCUP
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:845-561-6305
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:VAILS GATE
Mailing Address - State:NY
Mailing Address - Zip Code:12584-0006
Mailing Address - Country:US
Mailing Address - Phone:845-561-6305
Mailing Address - Fax:845-561-6839
Practice Address - Street 1:384 RTE 32
Practice Address - Street 2:INSIDE SHOPRITE
Practice Address - City:VAILS GATE
Practice Address - State:NY
Practice Address - Zip Code:12584
Practice Address - Country:US
Practice Address - Phone:845-561-6305
Practice Address - Fax:845-561-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07869156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00644082Medicaid
NY00644082Medicaid