Healthcare Provider Details

I. General information

NPI: 1568904548
Provider Name (Legal Business Name): WYCKOFF OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 FRANKLIN AVE
WYCKOFF NJ
07481-1909
US

IV. Provider business mailing address

400 FRANKLIN AVE
WYCKOFF NJ
07481-1347
US

V. Phone/Fax

Practice location:
  • Phone: 201-560-1000
  • Fax: 201-560-0573
Mailing address:
  • Phone: 201-560-1000
  • Fax: 201-560-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00544400
License Number StateNJ

VIII. Authorized Official

Name: MRS. CHRISTINE FULMER
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 201-560-1000