Provider Demographics
NPI:1740512433
Name:JAH OPTICAL, INC.
Entity type:Organization
Organization Name:JAH OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-982-9866
Mailing Address - Street 1:2 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4109
Mailing Address - Country:US
Mailing Address - Phone:718-963-1177
Mailing Address - Fax:
Practice Address - Street 1:2 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4109
Practice Address - Country:US
Practice Address - Phone:718-963-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002946-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02877470Medicaid