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General NPI Number Information
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NPI Number | 1669226767
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Entity Type | Organization
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Legal Business Name | MONTCLAIR FAMILY EYECARE
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Dates
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Enumeration Date | 04/15/2024
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 547 VALLEY RD
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1880
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Country | US
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Telephone | 973-783-6446
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Fax | 973-783-6448
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Provider Business Mailing Address
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Address Line | 547 VALLEY RD
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1880
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Country | US
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Telephone | 973-783-6446
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Fax | 973-783-6448
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OD
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Name | ANDREA ANTONELLI
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Credential | OD
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Telephone | 770-356-0692
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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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