Organization
J A K ENTERPRISES INC
Active
Other names
Bard Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA J. HALL (PRESIDENT)
(309) 693-9540
Entity
Organization
Contact information
Practice address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 713-3664
(309) 839-0078
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9542
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046010457
IL
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/05/2013
Last updated
04/22/2025
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