JEA OPTICAL LLC (NPI# 1720542855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720542855 |
| Entity Type | Organization |
| Organization Name | JEA OPTICAL LLC |
| Practice Address |
1200 N State St Ste 110 Jackson MS 39202-2027 |
| Mailing Address |
1200 N State St Ste 330 Jackson MS 39202-2027 |
| Practice Telephone | 6013520025 |
| Practice Fax Number | 6013520037 |
| Mailing Telephone | 6013532020 |
| Mailing Fax Number | 6013525988 |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |
| Authorized Official Name | ROBERT AMORY MALLETTE (MANAGING PARTNER) |
| Authorized Official Telephone | 6013532020 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 102 Clinton Pkwy, Clinton, MS 390564730 | 6019249750 | 6019259791 |
| 401 Baptist Dr Ste 201, Madison, MS 391102009 | 6018532020 | 6018532728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023572823 | Jea Optical LLC | Durable Medical Equipment & Medical Supplies | 102 Clinton Pkwy, Clinton, MS 39056-4730 | 2019-01-25 |
| 1215491014 | Jea Optical LLC | Durable Medical Equipment & Medical Supplies | 401 Baptist Dr Ste 201, Madison, MS 39110-2009 | 2019-01-25 |
| Street Address |
1200 N STATE ST STE 110 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700432754 | Encore Care Inc | Durable Medical Equipment & Medical Supplies | 55 N County Line Rd Ste 6, Jackson, NJ 08527-1394 | 2019-08-15 |
| 1689142317 | 3 B Labs | Durable Medical Equipment & Medical Supplies | 3011 Greystone Sq, Jackson, TN 38305-3590 | 2018-11-12 |
| 1043726896 | Elite Medical Supply | Durable Medical Equipment & Medical Supplies | 1166 Greenway Dr Ste A3, Jackson, MO 63755-2919 | 2017-12-15 |
| 1124551205 | Quincy Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 5303 Old Cape Rd E Ste A, Jackson, MO 63755-3850 | 2017-04-06 |
| 1295277952 | G & N Enterprise, LLC | Durable Medical Equipment & Medical Supplies | 460 Briarwood Dr Ste 100, Jackson, MS 39206-3053 | 2016-11-12 |
| 1417305665 | J.u.s.t. Orthotics | Durable Medical Equipment & Medical Supplies | 1020 Aspen Dr, Jackson, MO 63755-1152 | 2016-05-27 |
| 1710332325 | Apex Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 189 N Lacey St, Suite 2, Jackson, MO 63755-2496 | 2016-05-02 |
| 1366800914 | Georgia Ophthalmologists LLC | Durable Medical Equipment & Medical Supplies | 860 W 3rd St, Jackson, GA 30233 | 2016-02-10 |
| 1285099192 | At-home Medical Supply | Durable Medical Equipment & Medical Supplies | 5015 I 55 N Ste B, Jackson, MS 39206-4306 | 2015-12-18 |
| 1932570454 | Lhc Medical Supplies | Durable Medical Equipment & Medical Supplies | 5725 Highway 18 W, Jackson, MS 39209-9604 | 2015-10-09 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.