Healthcare Provider Details

I. General information

NPI: 1639425028
Provider Name (Legal Business Name): URBAN EYES INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 BROAD ST
NEWARK NJ
07102-3717
US

IV. Provider business mailing address

787 BROAD ST
NEWARK NJ
07102-3717
US

V. Phone/Fax

Practice location:
  • Phone: 973-643-3343
  • Fax: 973-643-3369
Mailing address:
  • Phone: 973-643-3343
  • Fax: 973-643-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY NESSES NESSES
Title or Position: OWNER
Credential:
Phone: 973-643-3343