Organization Name: | JMJ AVENUE EYEWEAR |
NPI Number: | 1124422100 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JODIE COHEN (OWNER/ OPTICIAN) |
Mailing Address: | 351b Matawan Rd Matawan |
State: | NJ US |
Postal Code: | 077473923 |
Phone Number: | 7325832800 |
Fax Number: | 7325832070 |
NPI Enumeration Date: | 10/20/2014 |
NPI Last Update Date: | 10/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 31TD00215401 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |