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General NPI Number Information
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NPI Number | 1083070924
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Entity Type | Organization
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Legal Business Name | STELLAR VISION LLC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 1933 STATE ROUTE 35 STE 120
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-3542
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Country | US
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Telephone | 732-449-9503
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Fax | 732-974-7120
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Provider Business Mailing Address
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Address Line | 722 WALL RD
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City | SPRING LAKE
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State | NJ
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Zip | 07762-2237
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Country | US
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Telephone | 732-735-0377
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAYA BRADY
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Credential | O.D.
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Telephone | 732-735-0377
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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 |
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License Number State | NJ
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