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General NPI Number Information
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NPI Number | 1043387178
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Entity Type | Organization
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Legal Business Name | TRUWAY VISION CARE PA
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 311 MAIN ST
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City | ORANGE
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State | NJ
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Zip | 07050-3607
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Country | US
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Telephone | 973-673-5773
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Fax | 973-673-5794
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Provider Business Mailing Address
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Address Line | 311 MAIN ST
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City | ORANGE
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State | NJ
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Zip | 07050-3607
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Country | US
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Telephone | 973-673-5773
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Fax | 973-673-5794
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. STELLAMARIA NGOZI KORIEOCHA
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Credential | OD
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Telephone | 973-673-5773
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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 | 27OA00549800
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License Number State | NJ
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