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General NPI Number Information
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NPI Number | 1417124140
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Entity Type | Organization
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Legal Business Name | ROCKAWAY EYECARE
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 343 MOUNT HOPE AVE SUITE 2
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City | ROCKAWAY
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State | NJ
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Zip | 07866-1644
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Country | US
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Telephone | 973-366-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 343 MOUNT HOPE AVE SUITE 2
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City | ROCKAWAY
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State | NJ
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Zip | 07866-1644
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Country | US
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Telephone | 973-366-1181
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Fax |
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Authorized Official
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Title or Position | FRANCHISEE/OPTICIAN
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Name | ROBERT C HALL
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Credential | LDO
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Telephone | 973-366-1181
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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 | LD1355
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License Number State | NJ
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