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General NPI Number Information
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NPI Number | 1164911400
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Entity Type | Organization
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Legal Business Name | J & J OPTICAL
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 2120 LAZELLE ST
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City | STURGIS
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State | SD
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Zip | 57785-1316
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Country | US
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Telephone | 605-347-9117
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Fax | 605-347-8652
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Provider Business Mailing Address
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Address Line | 2120 LAZELLE ST
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City | STURGIS
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State | SD
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Zip | 57785-1316
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Country | US
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Telephone | 605-347-9117
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Fax | 605-347-8652
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Authorized Official
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Title or Position | OWNER
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Name | JUBAL SHAWN PILLEN
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Credential | OPTICIAN
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Telephone | 605-347-9117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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