1942689898 NPI number — JSD EYECARE, LLC

Table of content: (NPI 1942689898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942689898 NPI number — JSD EYECARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JSD EYECARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942689898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1556 INVERNESS COVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-4549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-915-8899
Provider Business Mailing Address Fax Number:
205-833-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 SPRINGVILLE STA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35146-6162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-915-8899
Provider Business Practice Location Address Fax Number:
205-833-3059
Provider Enumeration Date:
05/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DETLOFF
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
SIEBER
Authorized Official Title or Position:
OPTOMETRIST/ OWNER
Authorized Official Telephone Number:
205-915-8899

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265586473 . This is a "PERSONAL NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com