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General NPI Number Information
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NPI Number | 1386952885
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Entity Type | Organization
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Legal Business Name | VISION DEVELOPMENT CENTER OF MULLICA HILL NEW JERSEY
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 10 BAKER BLVD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-1504
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Country | US
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Telephone | 856-223-1626
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Fax | 856-223-1626
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Provider Business Mailing Address
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Address Line | 10 BAKER BLVD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-1504
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Country | US
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Telephone | 856-223-1626
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Fax | 856-223-1626
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. TAMARA KOSTICK
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Credential |
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Telephone | 856-223-1626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | TO00525
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License Number State | NJ
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