Organization
JRGOLD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES JAMES GOLDSTEIM I O.D. (OWNER)
(217) 258-8466
Entity
Organization
Contact information
Practice address
1120 LAKE LAND BLVD STE 1, MATTOON, IL 61938-5562
(217) 258-8466
(217) 258-8443
Mailing address
1120 LAKE LAND BLVD STE 1, MATTOON, IL 61938-5562
(217) 258-8466
(217) 258-8443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007322
IL
332H00000X
Eyewear Supplier
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007322
—
IL
Enumeration date
05/21/2007
Last updated
08/12/2008
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