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General NPI Number Information
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NPI Number | 1699954610
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Entity Type | Organization
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Legal Business Name | OPTIC ONE, INC.
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 2401 ROUTE 130 S
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3020
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Country | US
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Telephone | 856-786-1616
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Fax | 856-786-3565
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Provider Business Mailing Address
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Address Line | 2401 ROUTE 130 S
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3020
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Country | US
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Telephone | 856-786-1616
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Fax | 856-786-3565
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOSEPH JAMES REDA JR.
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Credential | O.D.
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Telephone | 856-786-1616
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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 | 27OA00470000
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License Number State | NJ
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