Provider Demographics
NPI:1780274506
Name:JEC LLC
Entity type:Organization
Organization Name:JEC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-272-0453
Mailing Address - Street 1:409 AGNES AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8746
Mailing Address - Country:US
Mailing Address - Phone:406-546-6854
Mailing Address - Fax:406-221-3754
Practice Address - Street 1:1200 W KENT AVE STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6609
Practice Address - Country:US
Practice Address - Phone:406-272-0453
Practice Address - Fax:406-221-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty