Healthcare Provider Details

I. General information

NPI: 1467457119
Provider Name (Legal Business Name): JOHN L VOLPE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 HAY AVE
NUTLEY NJ
07110-1908
US

IV. Provider business mailing address

62 HAY AVE
NUTLEY NJ
07110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 973-667-8853
  • Fax: 973-667-8853
Mailing address:
  • Phone: 973-667-8853
  • Fax: 973-667-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00468100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: