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General NPI Number Information
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NPI Number | 1720228729
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Entity Type | Organization
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Legal Business Name | TOTAL FAMILY VISION LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 1636 ROUTE 38 UNIT 48
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City | LUMBERTON
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State | NJ
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Zip | 08048-2900
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Country | US
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Telephone | 609-702-7300
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Fax | 609-702-7385
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Provider Business Mailing Address
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Address Line | 1636 ROUTE 38 UNIT 48
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City | LUMBERTON
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State | NJ
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Zip | 08048-2900
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Country | US
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Telephone | 609-702-7300
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Fax | 609-702-7385
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA A. OLIVO
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Credential | OD
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Telephone | 609-702-7300
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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 | OA05517
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License Number State | NJ
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