Healthcare Provider Details

I. General information

NPI: 1982976452
Provider Name (Legal Business Name): OPTICAL CONNECTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S HOPE CHAPEL RD STE 105
JACKSON NJ
08527-5000
US

IV. Provider business mailing address

21 S HOPE CHAPEL RD STE 105
JACKSON NJ
08527-5000
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-8022
  • Fax: 732-370-8037
Mailing address:
  • Phone: 732-370-8022
  • Fax: 732-370-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARY GAILIS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 732-244-4400