Organization
J BASS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA TEPOVICH (MANAGER)
(618) 244-0508
Entity
Organization
Contact information
Practice address
112 S 42ND STREET, MT. VERNON, IL 62864
(618) 244-0508
(618) 244-0646
Mailing address
112 S 42ND STREET, MT. VERNON, IL 62864
(618) 244-0508
(618) 244-0646
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922009950
BCBS
IL
01
—
DE6294
RR MEDICARE
IL
Enumeration date
12/06/2006
Last updated
09/13/2011
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