Healthcare Provider Details

I. General information

NPI: 1477060267
Provider Name (Legal Business Name): MONTENARE EYE CARE & VISION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 CEDAR HILL AVE STE H
WYCKOFF NJ
07481-2150
US

IV. Provider business mailing address

541 CEDAR HILL AVE
WYCKOFF NJ
07481-2150
US

V. Phone/Fax

Practice location:
  • Phone: 631-455-7123
  • Fax:
Mailing address:
  • Phone: 201-857-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00641300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27OA00641300
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL MONTENARE
Title or Position: OWNER
Credential:
Phone: 201-857-5111