Provider Demographics
NPI:1174744288
Name:JAZZY EYES, INC.
Entity type:Organization
Organization Name:JAZZY EYES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KIMMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-474-9823
Mailing Address - Street 1:2279 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5828
Mailing Address - Country:US
Mailing Address - Phone:954-474-9823
Mailing Address - Fax:954-474-7832
Practice Address - Street 1:2279 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5828
Practice Address - Country:US
Practice Address - Phone:954-474-9823
Practice Address - Fax:954-474-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE0000561332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier