Healthcare Provider Details

I. General information

NPI: 1386069045
Provider Name (Legal Business Name): JFJ EYECARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FOUNTAINS PKWY SUITE D
FAIRVIEW HEIGHTS IL
62208-2165
US

IV. Provider business mailing address

111 W LINCOLN ST
BELLEVILLE IL
62220-2019
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 618-937-8403
Mailing address:
  • Phone: 618-234-1774
  • Fax: 618-937-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA L CUMMINS
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 618-722-5740