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General NPI Number Information
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NPI Number | 1174947691
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Entity Type | Organization
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Legal Business Name | LIBERTY EYE CARE
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 3452 BROIDY RD
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City | TRENTON
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State | NJ
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Zip | 08641-5305
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Country | US
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Telephone | 609-723-8957
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Fax | 609-723-6760
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Provider Business Mailing Address
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Address Line | 3452 BROIDY RD
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City | TRENTON
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State | NJ
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Zip | 08641-5305
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Country | US
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Telephone | 609-723-8957
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Fax | 609-723-6760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT JOHN GAMUZZA
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Credential | OD
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Telephone | 609-723-8957
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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 | 27OA00646500
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License Number State | NJ
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