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General NPI Number Information
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NPI Number | 1164825303
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Entity Type | Organization
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Legal Business Name | JYC EYE CARE
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 200 ENGLE ST #12
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-569-2442
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Fax | 201-569-2552
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Provider Business Mailing Address
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Address Line | 200 ENGLE ST #12
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-569-2442
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Fax | 201-569-2552
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA J CHOI-LEE
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Credential | O.D
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Telephone | 201-916-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 27OA00614200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 27OA00614200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00614200
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License Number State | NJ
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