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General NPI Number Information
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NPI Number | 1790970093
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Entity Type | Organization
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Legal Business Name | JADA LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 21 OAK ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-445-3189
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Fax | 201-445-7111
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Provider Business Mailing Address
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Address Line | 21 OAK ST LEVATO & GAUDIOMONTE OPTICIANS
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3805
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Country | US
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Telephone | 201-445-3189
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Fax | 201-445-7111
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Authorized Official
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Title or Position | OWNER / OPTICIAN
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Name | MR. DON M AXELBAND
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Credential | LICENSED OPTICIAN
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Telephone | 201-445-3189
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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 | D-1282
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License Number State | NJ
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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 | D-1282
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License Number State | NJ
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