=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295287233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLINK VISION CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2016
-----------------------------------------------------
Last Update Date | 12/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 S LIVINGSTON AVE SUITE #5
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-533-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 S LIVINGSTON AVE SUITE #5
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUDY TSAI
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 973-533-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00634600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------