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General NPI Number Information
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NPI Number | 1194912154
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Entity Type | Organization
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Legal Business Name | PASSAIC VISION CENTER ,LLC.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 289 MONROE ST. PASSAIC VISION CENTER
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City | PASSAIC
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State | NJ
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Zip | 07055-5209
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Country | US
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Telephone | 973-473-5151
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Fax | 973-473-3331
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Provider Business Mailing Address
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Address Line | PO BOX 1758
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City | CLIFTON
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State | NJ
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Zip | 07015-1758
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Country | US
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Telephone | 973-473-5151
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Fax | 973-473-3331
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Authorized Official
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Title or Position | OWNER
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Name | LUIS MENDOZA
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Credential | MD
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Telephone | 973-473-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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