Healthcare Provider Details

I. General information

NPI: 1982929311
Provider Name (Legal Business Name): PERFECT VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BOULEVARD
KENILWORTH NJ
07033-1603
US

IV. Provider business mailing address

505 BOULEVARD
KENILWORTH NJ
07033-1603
US

V. Phone/Fax

Practice location:
  • Phone: 908-272-3293
  • Fax: 908-276-5227
Mailing address:
  • Phone: 908-272-3293
  • Fax: 908-276-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00078200
License Number StateNJ

VIII. Authorized Official

Name: DR. LOIS G. FIORE
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 908-272-3293