Healthcare Provider Details

I. General information

NPI: 1902271042
Provider Name (Legal Business Name): JETEYE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 22
SPRINGFIELD NJ
07081-3554
US

IV. Provider business mailing address

1278 HOOPER AVENUE
TOMS RIVER NJ
08753-3343
US

V. Phone/Fax

Practice location:
  • Phone: 732-505-0533
  • Fax: 732-505-6572
Mailing address:
  • Phone: 973-376-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RANDY S NISSINOFF
Title or Position: OWNER/OPERATOR
Credential: OD
Phone: 973-376-7900