Healthcare Provider Details

I. General information

NPI: 1053391219
Provider Name (Legal Business Name): DOUBLE VISION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 RTE 34 SUITE F, MARKETPLACE MALL
MATAWAN NJ
07747-9506
US

IV. Provider business mailing address

443 RTE 34 SUITE F, MARKETPLACE MALL
MATAWAN NJ
07747-9506
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 Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number270A00505900
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN G LIPCHAK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 732-583-3600