Healthcare Provider Details

I. General information

NPI: 1801975347
Provider Name (Legal Business Name): VAIRONA MIKHAIL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 CRANBURY RD SUITE E
EAST BRUNSWICK NJ
08816-5400
US

IV. Provider business mailing address

561 CRANBURY RD SUITE E
EAST BRUNSWICK NJ
08816-5400
US

V. Phone/Fax

Practice location:
  • Phone: 732-721-6641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00585600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: