Organization Name: | ATLANTIC EYE CENTER OPTICAL LIN |
NPI Number: | 1124152087 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL J CARUSO (PRESIDENT) |
Mailing Address: | 200 New Rd Linwood |
State: | NJ US |
Postal Code: | 082211306 |
Phone Number: | 6096532201 |
Fax Number: | 6096532215 |
NPI Enumeration Date: | 03/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 31TD00181200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |