Provider Demographics
NPI:1386069045
Name:JFJ EYECARE LTD
Entity type:Organization
Organization Name:JFJ EYECARE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-722-5740
Mailing Address - Street 1:111 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2019
Mailing Address - Country:US
Mailing Address - Phone:618-234-1774
Mailing Address - Fax:618-937-8403
Practice Address - Street 1:314 FOUNTAINS PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2165
Practice Address - Country:US
Practice Address - Phone:636-200-4393
Practice Address - Fax:618-937-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295778587OtherNPI
IL1295778587OtherNPI
IL203195Medicare PIN