Healthcare Provider Details

I. General information

NPI: 1437329513
Provider Name (Legal Business Name): JAMES OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 NAVARRE AVE STE 204
OREGON OH
43616-3276
US

IV. Provider business mailing address

2737 NAVARRE AVE STE 204
OREGON OH
43616-3276
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-3376
  • Fax: 419-693-7519
Mailing address:
  • Phone: 419-693-3376
  • Fax: 419-693-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC 2077
License Number StateOH

VIII. Authorized Official

Name: WILFRED JAMES FENNEWALD
Title or Position: LICENSED OPTICAN
Credential: L.D.O.
Phone: 419-693-3376