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General NPI Number Information
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NPI Number | 1477898260
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Entity Type | Organization
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Legal Business Name | JOHN BRIAN CUDLIPP,OD
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 681 S BROADWAY SUITE 1
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City | PENNSVILLE
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State | NJ
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Zip | 08070-2637
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Country | US
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Telephone | 856-935-3937
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Fax | 856-935-4445
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | PENNSVILLE
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State | NJ
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Zip | 08070-0187
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Country | US
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Telephone | 856-935-3937
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Fax | 856-935-4445
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. JOHN BRIAN CUDLIPP
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Credential | O.D.
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Telephone | 856-935-3937
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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 | OA04898
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License Number State | NJ
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