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General NPI Number Information
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NPI Number | 1619613312
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Entity Type | Organization
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Legal Business Name | BOGOTA FAMILY EYE CARE LLC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 137 QUEEN ANNE RD
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City | BOGOTA
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State | NJ
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Zip | 07603-1623
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Country | US
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Telephone | 201-488-7855
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Fax | 201-488-1636
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Provider Business Mailing Address
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Address Line | 137 QUEEN ANNE RD
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City | BOGOTA
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State | NJ
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Zip | 07603-1623
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Country | US
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Telephone | 201-488-7855
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Fax | 201-488-1636
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Authorized Official
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Title or Position | OD/PRESIDENT
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Name | DR. DIANE A KING
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Credential | OD
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Telephone | 201-488-7855
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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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