Healthcare Provider Details

I. General information

NPI: 1710048178
Provider Name (Legal Business Name): RONALD N CAUCHARD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 CLINTON AVE
WYCKOFF NJ
07481-1970
US

IV. Provider business mailing address

373 CLINTON AVE
WYCKOFF NJ
07481-1970
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-2772
  • Fax: 201-891-2702
Mailing address:
  • Phone: 201-891-2772
  • Fax: 201-891-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4048
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: