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General NPI Number Information
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NPI Number | 1619277704
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Entity Type | Organization
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Legal Business Name | BERGEN EYE CARE CLINIC LIMITED LIABILTY COMPANY
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Dates
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Enumeration Date | 10/24/2010
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 910 BERGEN AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-4314
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Country | US
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Telephone | 201-610-0980
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Fax | 201-610-0822
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Provider Business Mailing Address
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Address Line | 910 BERGEN AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-4314
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Country | US
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Telephone | 201-610-0980
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Fax | 201-610-0822
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. YURIJ TRYTJAK
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Credential | OD
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Telephone | 201-610-0980
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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 | 27OA00357400
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License Number State | NJ
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