Healthcare Provider Details

I. General information

NPI: 1508106105
Provider Name (Legal Business Name): DUSZAK EYE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 HIGHWAY 77
BRIDGETON NJ
08302-5988
US

IV. Provider business mailing address

1130 HIGHWAY 77
BRIDGETON NJ
08302-5988
US

V. Phone/Fax

Practice location:
  • Phone: 856-453-2739
  • Fax: 856-453-2802
Mailing address:
  • Phone: 856-453-2739
  • Fax: 856-453-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00613700
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT S DUSZAK
Title or Position: OPTOMETRIST, OWNER
Credential: O.D.
Phone: 215-520-2329