Provider Demographics
NPI:1952745325
Name:JJS OPTICAL LLC
Entity Type:Organization
Organization Name:JJS OPTICAL LLC
Other - Org Name:COTTAGE GROVE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-963-8886
Mailing Address - Street 1:7420 E POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3025
Mailing Address - Country:US
Mailing Address - Phone:651-459-9696
Mailing Address - Fax:651-459-4633
Practice Address - Street 1:7420 E POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3025
Practice Address - Country:US
Practice Address - Phone:651-459-9696
Practice Address - Fax:651-459-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty