MEDICARE: JLS OPTICAL CORP.

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	152W00000X	Optometrist	002877	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407920598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLS OPTICAL CORP.

Provider Business Mailing Address
First Line	:	5171 KINGS PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5218
Country	:	US
Telephone Number	:	718-951-9800
Fax Number	:	718-252-3736

Provider Business Practice Location Address
First Line	:	5171 KINGS PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5218
Country	:	US
Telephone Number	:	718-951-9800
Fax Number	:	718-252-3736

Authorized Official
Title or Position	:	ASSISTANT
Name	:	MICHELLE ERICKSEN
Credential	:
Telephone Number	:	718-951-9800

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/23/2013

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Directions to “JLS OPTICAL CORP. ” Practice Location

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