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General NPI Number Information
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NPI Number | 1417540501
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Entity Type | Organization
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Legal Business Name | KEARNY VISION CENTER OD PC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 405 KEARNY AVE
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City | KEARNY
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State | NJ
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Zip | 07032-2648
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Country | US
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Telephone | 201-866-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 405 KEARNY AVE
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City | KEARNY
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State | NJ
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Zip | 07032-2648
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Country | US
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Telephone | 201-866-2020
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Fax |
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Authorized Official
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Title or Position | OD
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Name | CHUNG LEE
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Credential | CHUNG LEE
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Telephone | 201-866-2020
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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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