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General NPI Number Information
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NPI Number | 1841644382
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Entity Type | Organization
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Legal Business Name | JAK OPTICAL, LLC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 9301 N CENTRAL EXPY STE 180 TOWER II
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City | DALLAS
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State | TX
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Zip | 75231-0821
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Country | US
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Telephone | 214-253-0202
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Fax | 214-253-0203
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Provider Business Mailing Address
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Address Line | 9301 N CENTRAL EXPY STE 180 TOWER II
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City | DALLAS
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State | TX
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Zip | 75231-0821
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Country | US
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Telephone | 214-253-0200
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Fax | 214-253-0201
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JUDITH ANNE KIRBY
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Credential | MD
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Telephone | 214-202-6003
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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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