Healthcare Provider Details

I. General information

NPI: 1396012910
Provider Name (Legal Business Name): DEYONG'S EYEWORLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 SAINT GEORGES AVE
COLONIA NJ
07067-4049
US

IV. Provider business mailing address

1009 SAINT GEORGES AVE
COLONIA NJ
07067-4049
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00375500
License Number StateNJ

VIII. Authorized Official

Name: DR. ALAN ZASTROW
Title or Position: OPTOMETRIST
Credential:
Phone: 732-634-8600