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General NPI Number Information
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NPI Number | 1326271545
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Entity Type | Organization
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Legal Business Name | B&B EYE GROUP LLC
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 461 STATE ROUTE 10 LEDGEWOOD MALL
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City | LEDGEWOOD
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State | NJ
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Zip | 07852-9510
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Country | US
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Telephone | 973-927-1242
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Fax | 973-927-8055
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Provider Business Mailing Address
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Address Line | 461 STATE ROUTE 10 LEDGEWOOD MALL
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City | LEDGEWOOD
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State | NJ
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Zip | 07852-9510
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Country | US
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Telephone | 973-927-1242
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Fax | 973-927-8055
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ROBERT GENE KIRCZOW
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Credential | O.D.
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Telephone | 973-927-1242
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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 | 27OA00376500
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License Number State | NJ
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