Healthcare Provider Details

I. General information

NPI: 1295901494
Provider Name (Legal Business Name): IMPERIAL EYEWEAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 RIVER AVENUE
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

227 RIVER AVENUE
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-7784
  • Fax: 732-367-7794
Mailing address:
  • Phone: 732-367-7784
  • Fax: 732-367-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number205897704
License Number StateNJ

VIII. Authorized Official

Name: MRS. TZIPPY ABRAMOWITZ
Title or Position: OWNER
Credential: OPTICIAN
Phone: 732-367-7784