Provider Demographics
NPI:1447302377
Name:JOOS OPTICAL INC
Entity type:Organization
Organization Name:JOOS OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-654-2527
Mailing Address - Street 1:402 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-654-2527
Mailing Address - Fax:740-653-3542
Practice Address - Street 1:402 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-654-2527
Practice Address - Fax:740-653-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410497Medicaid
OH0410497Medicaid
0708710001Medicare ID - Type Unspecified