Provider Demographics
NPI:1841644382
Name:JAK OPTICAL, LLC
Entity type:Organization
Organization Name:JAK OPTICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-202-6003
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:STE 180 TOWER II
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0821
Mailing Address - Country:US
Mailing Address - Phone:214-253-0200
Mailing Address - Fax:214-253-0201
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:STE 180 TOWER II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0821
Practice Address - Country:US
Practice Address - Phone:214-253-0202
Practice Address - Fax:214-253-0203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUDITH A KIRBY MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-21
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier