MEDICARE: EYE CONTACT VISION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1100X	Ophthalmic Technician/Technologist	31TD00152800	NJ

General Provider Information

NPI Number	:	1871716266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CONTACT VISION CENTER

Provider Business Mailing Address
First Line	:	106 FERRY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2106
Country	:	US
Telephone Number	:	973-589-8085
Fax Number	:	973-589-2891

Provider Business Practice Location Address
First Line	:	106 FERRY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2106
Country	:	US
Telephone Number	:	973-589-8085
Fax Number	:	973-589-2891

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER FRANK PANTOLIANO
Credential	:
Telephone Number	:	973-589-8085

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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Directions to “EYE CONTACT VISION CENTER ” Practice Location

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