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General NPI Number Information
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NPI Number | 1669976494
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Entity Type | Organization
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Legal Business Name | REVITAL EYES NJ INC
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1515 RT 22 WEST
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City | WATCHUNG
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State | NJ
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Zip | 07069
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Country | US
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Telephone | 347-937-0500
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Fax | 347-937-0500
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Provider Business Mailing Address
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Address Line | 32 BELMAR STREET
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 347-937-0500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD KARIM
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Credential |
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Telephone | 347-937-0500
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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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