Healthcare Provider Details

I. General information

NPI: 1598343758
Provider Name (Legal Business Name): OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 ROUTE 34 STE F
MATAWAN NJ
07747-9506
US

IV. Provider business mailing address

786 HIGHWAY 35
MIDDLETOWN NJ
07748-3410
US

V. Phone/Fax

Practice location:
  • Phone: 732-583-3600
  • Fax: 732-583-3770
Mailing address:
  • Phone: 732-583-3600
  • Fax: 732-583-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 636-200-4393