Healthcare Provider Details

I. General information

NPI: 1275965378
Provider Name (Legal Business Name): JURY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 E DOUGLAS AVE
WICHITA KS
67202-3510
US

IV. Provider business mailing address

926 E DOUGLAS AVE
WICHITA KS
67202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-6515
  • Fax: 678-928-0651
Mailing address:
  • Phone: 316-247-6515
  • Fax: 678-928-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1282-3
License Number StateKS

VIII. Authorized Official

Name: DR. JAMES S JURY
Title or Position: MEMBER
Credential: O.D.
Phone: 316-247-6515