Healthcare Provider Details
I. General information
NPI: 1508537663
Provider Name (Legal Business Name): CLARITY FAMILY EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/27/2021
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
34-36 PROGRESS ST STE B4
EDISON NJ
08820-1197
US
IV. Provider business mailing address
34-36 PROGRESS ST STE B4
EDISON NJ
08820-1197
US
V. Phone/Fax
- Phone: 732-515-4405
- Fax: 732-515-4434
- Phone: 732-515-4405
- Fax: 732-515-4434
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 152WC0802X |
| Taxonomy | Corneal and Contact Management Optometrist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
MONICA
THI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 732-491-1419