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General NPI Number Information
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NPI Number | 1154542496
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Entity Type | Organization
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Legal Business Name | SSJ INCORPORATED
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 375 THOMAS MORE PKWY
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-2176
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Country | US
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Telephone | 859-341-5383
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Fax | 859-341-3504
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Provider Business Mailing Address
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Address Line | 500 THOMAS MORE PKWY
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-3454
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Country | US
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Telephone | 859-341-5383
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Fax | 859-495-0607
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS C MANDO
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Credential | OPTICIAN
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Telephone | 859-341-5383
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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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Taxonomy #2
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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 | KY
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