Healthcare Provider Details

I. General information

NPI: 1770667610
Provider Name (Legal Business Name): PM OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 ROUTE 73 S
MARLTON NJ
08053-9661
US

IV. Provider business mailing address

515 ROUTE 73 S
MARLTON NJ
08053-9661
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-2666
  • Fax: 856-983-7134
Mailing address:
  • Phone: 856-983-2666
  • Fax: 856-983-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD1321
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD1321
License Number StateNJ

VIII. Authorized Official

Name: MR. JEFFREY PONT
Title or Position: PRES
Credential:
Phone: 856-983-2666