Healthcare Provider Details

I. General information

NPI: 1295733095
Provider Name (Legal Business Name): THOMAS ALTMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MAIN ST
RIDGEFIELD PARK NJ
07660-1534
US

IV. Provider business mailing address

PO BOX 275
RIDGEFIELD PARK NJ
07660-0275
US

V. Phone/Fax

Practice location:
  • Phone: 201-440-1273
  • Fax: 201-440-1274
Mailing address:
  • Phone: 201-440-1273
  • Fax: 201-440-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003432-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00374800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00013300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCDS#D09092900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: