MEDICARE: JLI OPTICAL IN.

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	005893-1	NY

General Provider Information

NPI Number	:	1528260031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLI OPTICAL IN.

Provider Business Mailing Address
First Line	:	2555 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5848
Country	:	US
Telephone Number	:	718-698-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5848
Country	:	US
Telephone Number	:	718-698-9300
Fax Number	:

Authorized Official
Title or Position	:	PRES.
Name	:	MR. JAMES G CUMMINGS
Credential	:
Telephone Number	:	718-698-9300

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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