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General NPI Number Information
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NPI Number | 1568904548
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Entity Type | Organization
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Legal Business Name | WYCKOFF OPTICAL, INC.
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 360 FRANKLIN AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1909
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Country | US
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Telephone | 201-560-1000
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Fax | 201-560-0573
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Provider Business Mailing Address
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Address Line | 400 FRANKLIN AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1347
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Country | US
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Telephone | 201-560-1000
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Fax | 201-560-0573
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Authorized Official
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Title or Position | MEDICAL BILLING SPECIALIST
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Name | MRS. CHRISTINE FULMER
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Credential |
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Telephone | 201-560-1000
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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 | 27OA00544400
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License Number State | NJ
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