MEDICARE: J A K ENTERPRISES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1376581611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J A K ENTERPRISES INC

Provider Business Mailing Address
First Line	:	8309 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-2170
Country	:	US
Telephone Number	:	309-693-9540
Fax Number	:	309-693-9542

Provider Business Practice Location Address
First Line	:	7715 N GRAND PRAIRIE DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-9243
Country	:	US
Telephone Number	:	309-691-1320
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANA J HALL
Credential	:
Telephone Number	:	309-693-9540

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/02/2026

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Directions to “J A K ENTERPRISES INC ” Practice Location

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