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General NPI Number Information
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NPI Number | 1437484102
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Entity Type | Organization
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Legal Business Name | GALLERY EYE CENTER LLC
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 100 N HIGH STREET
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City | MILLVILLE
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State | NJ
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Zip | 08332
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Country | US
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Telephone | 856-327-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N HIGH STREET
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City | MILLVILLE
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State | NJ
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Zip | 08332
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Country | US
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Telephone | 856-327-5888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN D RENYO
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Credential | OD
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Telephone | 856-327-5888
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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 | 270A00259000
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License Number State | NJ
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