JLS Optical Corp.

Primary specialty

OptometristTaxonomy code 152W00000X

License

002877 Issued in NY

Legal business name

JLS OPTICAL CORP.

Practice address

5171 Kings PLZ
Brooklyn, NY 11234-5218

Phone

(718) 951-9800

Fax

(718) 252-3736

NPI assigned

Nov 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Ericksen

Title

Assistant

Phone

(718) 951-9800

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1407920598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 KINGS PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345218",
            "telephone_number": "718-951-9800",
            "fax_number": "718-252-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 KINGS PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345218",
            "telephone_number": "718-951-9800",
            "fax_number": "718-252-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLS OPTICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "ERICKSEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ASSISTANT",
        "authorized_official_telephone_number": "718-951-9800"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "002877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01982883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.