Organization
JAK ENTERPRISE INC
Active
Other names
Bard Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA J HALL (PREIDENT)
(309) 693-9540
Entity
Organization
Contact information
Practice address
206 W 1ST ST, GENESEO, IL 61254-1344
(309) 944-5351
Mailing address
7720 N CRESTLINE DR, PEORIA, IL 61615-1907
(309) 693-9540
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0295700019
DMERC MEDICARE LOCATION #
IL
Enumeration date
05/23/2006
Last updated
08/22/2020
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