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General NPI Number Information
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NPI Number | 1023227378
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Entity Type | Organization
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Legal Business Name | JORGENSON OPTICAL SUPPLY
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1901 S UNION AVE SUITE B-1001
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City | TACOMA
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State | WA
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Zip | 98405-1702
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Country | US
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Telephone | 253-572-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S UNION AVE SUITE B-1001
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City | TACOMA
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State | WA
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Zip | 98405-1702
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Country | US
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Telephone | 253-572-4522
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN K JORGENSON
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Credential |
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Telephone | 253-572-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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