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General NPI Number Information
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NPI Number | 1659406031
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Entity Type | Organization
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Legal Business Name | SPECTRUM OPTOMETRIC SERVICES
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1760 EASTON AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-1366
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Country | US
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Telephone | 732-356-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 623 EAGLE ROCK AVE # 391
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA BENNETT
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Credential | O.D.
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Telephone | 732-356-0110
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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 | 270A00564700
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License Number State | NJ
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