Healthcare Provider Details

I. General information

NPI: 1558064386
Provider Name (Legal Business Name): OPTIC ONE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 ROUTE 130 S
CINNAMINSON NJ
08077-3020
US

IV. Provider business mailing address

4423 ROUTE 130 S
BURLINGTON NJ
08016-2385
US

V. Phone/Fax

Practice location:
  • Phone: 856-786-1616
  • Fax: 856-786-3565
Mailing address:
  • Phone: 609-386-0202
  • Fax: 609-386-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DEAN LEVY
Title or Position: OWNER
Credential: DO
Phone: 856-786-1616