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General NPI Number Information
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NPI Number | 1154087435
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Entity Type | Organization
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Legal Business Name | BRIGHT EYES OPTOMETRY LLC
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 500 ROUTE 35 UNIT 510
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City | RED BANK
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State | NJ
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Zip | 07701-5038
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Country | US
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Telephone | 732-232-0267
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Fax |
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Provider Business Mailing Address
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Address Line | 80 TOWNSEND DR
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3130
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Country | US
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Telephone | 732-232-0267
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JESSICA HAAKE
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Credential | OD
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Telephone | 732-232-0267
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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 |
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