MEDICARE: JCS OPTICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1023022936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCS OPTICAL INC.

Provider Business Mailing Address
First Line	:	220 LYNN ST
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-2662
Country	:	US
Telephone Number	:	810-487-1669
Fax Number	:	810-605-0610

Provider Business Practice Location Address
First Line	:	1704 EAST HURON ROAD
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730
Country	:	US
Telephone Number	:	989-362-3478
Fax Number	:	989-362-2380

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD MERLE CLIBER
Credential	:
Telephone Number	:	810-487-1669

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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