Provider Demographics
NPI:1780823070
Name:JJS OPTICAL LLC
Entity type:Organization
Organization Name:JJS OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-227-6506
Mailing Address - Street 1:101 5TH ST E STE 281
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1862
Mailing Address - Country:US
Mailing Address - Phone:651-227-6506
Mailing Address - Fax:651-288-4740
Practice Address - Street 1:1304 4TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2029
Practice Address - Country:US
Practice Address - Phone:612-331-7100
Practice Address - Fax:612-331-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN1582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN165105600Medicaid
972N3MEOtherBLUE CROSS BLUE SHIELD (MATERIALS)
2115817OtherMEDICA
354K1MEOtherBLUE CROSS BLUE SHIELD (EXAMS)
126892OtherHEALTH PARTNERS
165577OtherUCARE MINNESOTA
972N3MEOtherBLUE CROSS BLUE SHIELD (MATERIALS)