Healthcare Provider Details

I. General information

NPI: 1043306533
Provider Name (Legal Business Name): JOHN SAQA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST WALMART VISION CENTER
MANVILLE NJ
08835-1358
US

IV. Provider business mailing address

100 NORTH MAIN ST. WALMART VISION CENTER
MANVILLE NJ
08835-0000
US

V. Phone/Fax

Practice location:
  • Phone: 908-575-9446
  • Fax:
Mailing address:
  • Phone: 908-575-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00550400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: