=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013195049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL EYES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 10/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 RIVER RD BLDG C, SUITE 2
-----------------------------------------------------
City | MONTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07045-9441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-335-5355
-----------------------------------------------------
Fax | 973-335-5455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 RIVER RD BLDG C, SUITE 2
-----------------------------------------------------
City | MONTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07045-9441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-335-5355
-----------------------------------------------------
Fax | 973-335-5455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DANIEL KRITZER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-335-5355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 31TD00104502
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------