Provider Demographics
NPI:1831805035
Name:JELEN OPTOMETRY INC.
Entity type:Organization
Organization Name:JELEN OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JELEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-428-4903
Mailing Address - Street 1:620 W YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4523
Mailing Address - Country:US
Mailing Address - Phone:559-674-6268
Mailing Address - Fax:559-691-4008
Practice Address - Street 1:620 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4523
Practice Address - Country:US
Practice Address - Phone:559-674-6268
Practice Address - Fax:559-691-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service