Healthcare Provider Details

I. General information

NPI: 1730503293
Provider Name (Legal Business Name): JC OPTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 DUBLIN BLVD
DUBLIN CA
94568-7564
US

IV. Provider business mailing address

4540 DUBLIN BLVD
DUBLIN CA
94568-7564
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-3937
  • Fax: 925-833-3985
Mailing address:
  • Phone: 925-833-3937
  • Fax: 925-833-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD7560
License Number StateCA

VIII. Authorized Official

Name: HANI ELMANKABADI
Title or Position: OWNER
Credential:
Phone: 925-963-6945