MEDICARE: J.E.D.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	156FX1800X	Optician	511	PR

General Provider Information

NPI Number	:	1821087388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.E.D.INC

Provider Business Mailing Address
First Line	:	PO BOX 374
Second Line	:
City	:	MERCEDITA
State	:	PR
Zip	:	00715-0374
Country	:	US
Telephone Number	:	787-848-4614
Fax Number	:	787-848-4614

Provider Business Practice Location Address
First Line	:	396 ZONA IND REPARADA 2
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-2347
Country	:	US
Telephone Number	:	787-848-4614
Fax Number	:	787-848-4614

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MERCEDES M DIAZ
Credential	:	OPTICIAN
Telephone Number	:	787-848-4614

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	06/25/2008

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