Healthcare Provider Details

I. General information

NPI: 1548095326
Provider Name (Legal Business Name): MAHANTRAJ VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FLUSHING WAY
SUNBURY OH
43074-9016
US

IV. Provider business mailing address

246 FLUSHING WAY
SUNBURY OH
43074-9016
US

V. Phone/Fax

Practice location:
  • Phone: 732-372-5746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ASHISH CHAUHAN
Title or Position: OWNER
Credential:
Phone: 732-372-5746