Healthcare Provider Details

I. General information

NPI: 1396063400
Provider Name (Legal Business Name): VISUAL EYES EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 US HIGHWAY 206 STE 150 BYRAM PLAZA
STANHOPE NJ
07874-3131
US

IV. Provider business mailing address

90 US HIGHWAY 206 STE 150
STANHOPE NJ
07874-3131
US

V. Phone/Fax

Practice location:
  • Phone: 973-691-0700
  • Fax:
Mailing address:
  • Phone: 973-691-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNJ 5045
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberNJ 2202
License Number StateNJ

VIII. Authorized Official

Name: COLLEEN M. CASATELLI-BRONDO
Title or Position: PRESIDENT
Credential:
Phone: 973-691-0700