Healthcare Provider Details

I. General information

NPI: 1801931589
Provider Name (Legal Business Name): LACEY VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MAIN ST
LANOKA HARBOR NJ
08734-2834
US

IV. Provider business mailing address

415 N MAIN ST PO BOX 367
LANOKA HARBOR NJ
08734-0367
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-8808
  • Fax: 609-242-1078
Mailing address:
  • Phone: 609-693-8808
  • Fax: 609-242-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4129
License Number StateNJ

VIII. Authorized Official

Name: DR. NATHAN FINK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 609-693-8808