Healthcare Provider Details

I. General information

NPI: 1629677638
Provider Name (Legal Business Name): JICHA VISION OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 E DIXIE DR
ASHEBORO NC
27203-8856
US

IV. Provider business mailing address

2607 BURCH PT
HIGH POINT NC
27265-9333
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-2458
  • Fax: 336-625-4982
Mailing address:
  • Phone: 336-688-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANNA POPA JICHA
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-688-5604