Healthcare Provider Details

I. General information

NPI: 1922543099
Provider Name (Legal Business Name): JEMS OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NEW YORK AVE NW
WASHINGTON DC
20005-2102
US

IV. Provider business mailing address

1401 NEW YORK AVE NW
WASHINGTON DC
20005-2102
US

V. Phone/Fax

Practice location:
  • Phone: 202-638-4700
  • Fax: 202-393-1527
Mailing address:
  • Phone: 202-638-4700
  • Fax: 202-393-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP536
License Number StateDC

VIII. Authorized Official

Name: DR. JAMES HOLLEY
Title or Position: OPTOMETRIST
Credential:
Phone: 202-638-4700