Healthcare Provider Details

I. General information

NPI: 1316469133
Provider Name (Legal Business Name): OMAR MUNSHI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 ROUTE 1
EDISON NJ
08837-2418
US

IV. Provider business mailing address

1465 ROUTE 1
EDISON NJ
08837-2418
US

V. Phone/Fax

Practice location:
  • Phone: 973-538-5287
  • Fax:
Mailing address:
  • Phone: 203-919-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00676900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00676901
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3027
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: