Healthcare Provider Details

I. General information

NPI: 1962209163
Provider Name (Legal Business Name): DEBBIE LYN ESPERACION LICENSED OPTICIAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 88TH ST
NORTH BERGEN NJ
07047-4709
US

IV. Provider business mailing address

2100 88TH ST
NORTH BERGEN NJ
07047-4709
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-2895
  • Fax: 201-758-2897
Mailing address:
  • Phone: 201-758-2895
  • Fax: 201-758-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00405400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: