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General NPI Number Information
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NPI Number | 1588746119
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Entity Type | Individual
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Provider Name | CHRISTIAN ANDRES MORILLO O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 875 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07102-2622
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Country | US
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Telephone | 973-622-4492
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Fax |
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Provider Business Mailing Address
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Address Line | 899 VALLEY RD
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City | WAYNE
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State | NJ
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Zip | 07470-2973
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Country | US
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Telephone | 862-221-9426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OA6023
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License Number State | NJ
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