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NPI Code Detail

MEDICARE: JAK ENTERPRISES DBA JAK OPTICAL LABORATORIES

MEDICARE: JAK ENTERPRISES DBA JAK OPTICAL LABORATORIES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1083158372
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAK ENTERPRISES DBA JAK OPTICAL LABORATORIES
Provider Business Mailing Address
First Line : PO BOX 3333
Second Line :
City : PEORIA
State : IL
Zip : 61612-3333
Country : US
Telephone Number : 309-713-1762
Fax Number : 309-966-0922
Provider Business Practice Location Address
First Line : 8309 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61615-2170
Country : US
Telephone Number : 800-654-2833
Fax Number : 800-322-1822
Authorized Official
Title or Position : PRESIDENT
Name : DIANA J HALL
Credential :
Telephone Number : 309-693-9540
Provider Enumeration Date : 12/06/2016
Last Update Date : 12/06/2016

Similar Medicare Providers

1508856923 — J A K ENTERPRISES INC
Practice Location Address:
8309 N KNOXVILLE AVE
PEORIA, IL
61615-2170
Practice Phone: 309-693-9540
Practice Fax:
1629319330 — J A K ENTERPRISES INC
Practice Location Address:
8309 N KNOXVILLE AVE
PEORIA, IL
61615-2170
Practice Phone: 309-713-3664
Practice Fax: 309-839-0078
1457374811 — MRS. KELI ELIZABETH JORDAN-GARDNER OD
Practice Location Address:
8309 N KNOXVILLE AVE
PEORIA, IL
61615-2170
Practice Phone: 309-693-9540
Practice Fax: 309-693-9542
1851342588 — DR. BARBARA E. OTT O.D.
Practice Location Address:
8309 N KNOXVILLE AVE
PEORIA, IL
61615-2170
Practice Phone: 309-713-3664
Practice Fax: 309-839-0078
1063965515 — LAURA WILSHIRE OD
Practice Location Address:
8309 N KNOXVILLE AVE , STE. 1
PEORIA, IL
61615-2170
Practice Phone: 309-713-3664
Practice Fax: 309-693-9754
1396411195 — ZAHRA TAHIR OD
Practice Location Address:
8309 N KNOXVILLE AVE
PEORIA, IL
61615-2170
Practice Phone: 309-693-9540
Practice Fax: 309-693-9542

Directions to “JAK ENTERPRISES DBA JAK OPTICAL LABORATORIES ” Practice Location

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