Healthcare Provider Details

I. General information

NPI: 1245627173
Provider Name (Legal Business Name): JFJ EYECARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RICHMOND AVE E
MATTOON IL
61938-4652
US

IV. Provider business mailing address

3990 N ILLINOIS ST
SWANSEA IL
62226-1919
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 217-234-3930
Mailing address:
  • Phone: 618-277-1130
  • Fax: 618-277-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number036104178
License Number StateIL

VIII. Authorized Official

Name: DR. BART AARON JONES
Title or Position: OWNER
Credential: MD
Phone: 618-532-1082