MEDICARE: JC OPTICAL INC.

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
1	156FX1800X	Optician	5711	CA

General Provider Information

NPI Number	:	1619198165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JC OPTICAL INC.

Provider Business Mailing Address
First Line	:	18414 COLIMA RD STE F
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2883
Country	:	US
Telephone Number	:	626-913-0042
Fax Number	:	626-913-7271

Provider Business Practice Location Address
First Line	:	18414 COLIMA RD STE F
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2883
Country	:	US
Telephone Number	:	626-913-0042
Fax Number	:	626-913-7271

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JENNY J TSAI
Credential	:	OPTICIAN
Telephone Number	:	626-913-0042

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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