Black, Jay Charles

Black, Jay Charles is an individual health care provider with primary practice located at 5316 N Second Street , Loves Park IL 61111-5009. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Black, Jay Charles can be contacted via phone (815) 877-6551.

Contact Information

Primary practice address
5316 N Second Street Loves Park IL 61111-5009
Phone: (815) 877-6551
Fax: (815) 877-4821
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 466709 Illinois

Profile Details

NPI number 1629113261
LBN Legal business name Black, Jay Charles
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629113261 NPPES
Illinois Other 362871342 FED ID NUMBER

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