Healthcare Provider Details

I. General information

NPI: 1699954610
Provider Name (Legal Business Name): OPTIC ONE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 ROUTE 130 S
CINNAMINSON NJ
08077-3020
US

IV. Provider business mailing address

2401 ROUTE 130 S
CINNAMINSON NJ
08077-3020
US

V. Phone/Fax

Practice location:
  • Phone: 856-786-1616
  • Fax: 856-786-3565
Mailing address:
  • Phone: 856-786-1616
  • Fax: 856-786-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00470000
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH JAMES REDA JR.
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 856-786-1616