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General NPI Number Information
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NPI Number | 1508160201
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Entity Type | Organization
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Legal Business Name | OLD BRIDGE VISION INC
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 1040 US HIGHWAY 9
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City | PARLIN
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State | NJ
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Zip | 08859-1401
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Country | US
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Telephone | 732-727-1811
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Fax | 732-727-6399
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Provider Business Mailing Address
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Address Line | 1040 US HIGHWAY 9
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City | PARLIN
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State | NJ
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Zip | 08859-1401
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Country | US
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Telephone | 732-727-1811
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Fax | 732-727-6399
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT J GREENBERG
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Credential |
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Telephone | 732-727-1811
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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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