Organization
JEA OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT AMORY MALLETTE MD (MANAGING PARTNER)
(601) 353-2020
Entity
Organization
Contact information
Practice address
401 BAPTIST DR STE 201, MADISON, MS 39110-2009
(601) 853-2020
(601) 853-2728
Mailing address
1200 N STATE ST STE 330, JACKSON, MS 39202-2027
(601) 352-0274
(601) 714-5110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/25/2019
Last updated
01/25/2019
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