Organization
J A K ENTERPRISES INC
Active
Other names
BARD OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA J HALL (PRESIDENT/OWNER)
(309) 693-9540
Entity
Organization
Contact information
Practice address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508856923
—
IL
01
—
7215175
BCBS
IL
Enumeration date
10/26/2005
Last updated
04/15/2025
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