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General NPI Number Information
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NPI Number | 1164577193
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Entity Type | Organization
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Legal Business Name | NEW JERSEY EYECARE ASSOCIATES OD PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1006 US HIGHWAY 46
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City | CLIFTON
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State | NJ
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Zip | 07013-2443
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Country | US
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Telephone | 973-777-9296
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Fax | 973-777-9297
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Provider Business Mailing Address
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Address Line | 1006 US HIGHWAY 46
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City | CLIFTON
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State | NJ
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Zip | 07013-2443
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Country | US
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Telephone | 973-777-9296
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Fax | 973-777-9297
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE MAZIE
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Credential | O.D.
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Telephone | 973-777-9296
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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 | 4594
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License Number State | NJ
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