Healthcare Provider Details

I. General information

NPI: 1073527073
Provider Name (Legal Business Name): JCS OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST
CHEBOYGAN MI
49721-1658
US

IV. Provider business mailing address

220 LYNN ST
FLUSHING MI
48433-2662
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-3149
  • Fax: 231-627-3855
Mailing address:
  • Phone: 810-487-1669
  • Fax: 810-605-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD MERLE CLIBER
Title or Position: OWNER
Credential:
Phone: 810-487-1669