Healthcare Provider Details

I. General information

NPI: 1467570820
Provider Name (Legal Business Name): NAZCO OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MORRIS AVE
ELIZABETH NJ
07208-3612
US

IV. Provider business mailing address

421 MORRIS AVE
ELIZABETH NJ
07208-3612
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-7374
  • Fax: 908-353-7106
Mailing address:
  • Phone: 908-353-7374
  • Fax: 908-353-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberTD2107
License Number StateNJ

VIII. Authorized Official

Name: FERNANDO NAZCO
Title or Position: PARTNER
Credential: OPTICIAN
Phone: 908-353-7374