Healthcare Provider Details

I. General information

NPI: 1831805035
Provider Name (Legal Business Name): JELEN OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W YOSEMITE AVE
MADERA CA
93637-4523
US

IV. Provider business mailing address

620 W YOSEMITE AVE
MADERA CA
93637-4523
US

V. Phone/Fax

Practice location:
  • Phone: 559-674-6268
  • Fax: 559-691-4008
Mailing address:
  • Phone: 559-674-6268
  • Fax: 559-691-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL JELEN
Title or Position: OWNER
Credential: OD
Phone: 310-428-4903