Healthcare Provider Details

I. General information

NPI: 1083894323
Provider Name (Legal Business Name): JCA OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 11/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 ROUTE 58
RIVERHEAD NY
11901-2019
US

IV. Provider business mailing address

1053 ROUTE 58
RIVERHEAD NY
11901-2019
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-7777
  • Fax: 631-727-7822
Mailing address:
  • Phone: 631-727-7777
  • Fax: 631-727-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number003078
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL A ALGIERI
Title or Position: OWNER
Credential:
Phone: 631-727-7777