Healthcare Provider Details

I. General information

NPI: 1376586685
Provider Name (Legal Business Name): JFJ EYECARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 N ILLINOIS ST
SWANSEA IL
62226
US

IV. Provider business mailing address

PO BOX 415000
NASHVILLE TN
37241-2019
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 618-277-6651
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: CMO
Credential:
Phone: 636-200-4393