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General NPI Number Information
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NPI Number | 1750820643
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Entity Type | Organization
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Legal Business Name | JCPL, LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 751 MASSACHUSETTS AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46204
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Country | US
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Telephone | 317-602-4810
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Fax |
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Provider Business Mailing Address
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Address Line | 751 MASSACHUSETTS AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46204
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Country | US
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Telephone | 317-602-4810
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID LEE RICH
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Credential | OD
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Telephone | 317-602-4810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003085A
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License Number State | IN
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