Healthcare Provider Details

I. General information

NPI: 1215333968
Provider Name (Legal Business Name): EYEGLASS CORNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 BROAD ST STE 2B
BLOOMFIELD NJ
07003-2635
US

IV. Provider business mailing address

199 BROAD ST STE 2B
BLOOMFIELD NJ
07003-2635
US

V. Phone/Fax

Practice location:
  • Phone: 973-337-8565
  • Fax:
Mailing address:
  • Phone: 973-337-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTHONY PETER D'AMATO
Title or Position: OWNER
Credential: M.D., F.A.C.S.
Phone: 973-337-8565