Healthcare Provider Details

I. General information

NPI: 1225186919
Provider Name (Legal Business Name): JOSEPH A. VIVIANO O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 DEFOREST AVE
SUMMIT NJ
07901-1930
US

IV. Provider business mailing address

52 DEFOREST AVE
SUMMIT NJ
07901-1930
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-3116
  • Fax: 908-273-4522
Mailing address:
  • Phone: 908-277-3116
  • Fax: 908-273-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270AOO278100
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH A. VIVIANO
Title or Position: OWNER
Credential: O.D.
Phone: 908-277-3116