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General NPI Number Information
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NPI Number | 1366455032
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Entity Type | Organization
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Legal Business Name | OPTICAL WORLD OF ELIZABETH LLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 206 BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07201-2304
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Country | US
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Telephone | 908-629-0011
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Fax | 908-629-1133
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Provider Business Mailing Address
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Address Line | 206 BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07201-2304
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Country | US
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Telephone | 908-629-0011
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Fax | 908-629-1133
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUKUL C RAITHATHA
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Credential |
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Telephone | 908-629-0011
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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 |
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License Number State |
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