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General NPI Number Information
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NPI Number | 1063798320
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Entity Type | Organization
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Legal Business Name | MAPLEWOOD VISION CARE, LLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 1955 SPRINGFIELD AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3441
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Country | US
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Telephone | 973-761-5313
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 SPRINGFIELD AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3441
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Country | US
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Telephone | 973-761-5313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS JOHN DELESIO
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Credential | O.D.
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Telephone | 973-761-5313
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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 | 27OA00375400
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License Number State | NJ
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