Healthcare Provider Details

I. General information

NPI: 1689640252
Provider Name (Legal Business Name): ERROL RUMMEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 W COUNTY LINE RD
JACKSON NJ
08527-2251
US

IV. Provider business mailing address

2206 W COUNTY LINE RD
JACKSON NJ
08527-2251
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-4111
  • Fax: 732-901-0314
Mailing address:
  • Phone: 732-364-4111
  • Fax: 732-901-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00275200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number27OA00275200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27OA00275200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: