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General NPI Number Information
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NPI Number | 1528511524
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Entity Type | Organization
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Legal Business Name | NJ OPTICAL INC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 355 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2923
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Country | US
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Telephone | 201-222-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 243 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3073
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Country | US
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Telephone | 201-222-5401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QI CHAO LUI
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Credential |
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Telephone | 201-222-6400
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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 | 27OM0078900
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License Number State | NJ
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