Provider Demographics
NPI:1962544932
Name:J GEORGE OPTICAL COMPANY
Entity type:Organization
Organization Name:J GEORGE OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-282-7377
Mailing Address - Street 1:1523 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2209
Mailing Address - Country:US
Mailing Address - Phone:716-282-7377
Mailing Address - Fax:716-282-7382
Practice Address - Street 1:1523 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2209
Practice Address - Country:US
Practice Address - Phone:716-282-7377
Practice Address - Fax:716-282-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0453130001Medicare NSC