Healthcare Provider Details

I. General information

NPI: 1487987244
Provider Name (Legal Business Name): MD OPTICAL & VITAMINS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 INMAN AVE SUITE 365.,
EDISON NJ
08820-1132
US

IV. Provider business mailing address

1115 INMAN AVE SUITE 365.,
EDISON NJ
08820-1132
US

V. Phone/Fax

Practice location:
  • Phone: 732-604-4487
  • Fax: 732-543-2603
Mailing address:
  • Phone: 732-604-4487
  • Fax: 732-543-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number25MA02048600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00351400
License Number StateNJ

VIII. Authorized Official

Name: RISHIPAUL SINGH
Title or Position: CEO
Credential:
Phone: 732-604-4487