Healthcare Provider Details

I. General information

NPI: 1366778458
Provider Name (Legal Business Name): JMH OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARDEN STATE PLZ T13A
PARAMUS NJ
07652-2417
US

IV. Provider business mailing address

1 GARDEN STATE PLZ T13A
PARAMUS NJ
07652-2417
US

V. Phone/Fax

Practice location:
  • Phone: 201-587-0122
  • Fax: 201-587-1301
Mailing address:
  • Phone: 201-587-0122
  • Fax: 201-587-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number31TD00362300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00362300
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN M HANNA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 201-587-0122