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General NPI Number Information
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NPI Number | 1023246469
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Entity Type | Organization
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Legal Business Name | WATCHUNG EYE CARE LLC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 40 SIRLING ROAD 201
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City | WATCHUNG
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State | NJ
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Zip | 07069-5900
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Country | US
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Telephone | 908-375-3125
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Fax | 908-375-3124
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Provider Business Mailing Address
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Address Line | 40 SIRLING ROAD 201
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City | WATCHUNG
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State | NJ
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Zip | 07069-5900
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Country | US
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Telephone | 908-375-3125
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Fax | 908-375-3124
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | XIAO-OU REN
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Credential | O.D
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Telephone | 908-769-6421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00014200
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License Number State | NJ
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