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General NPI Number Information
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NPI Number | 1740483502
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Entity Type | Organization
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Legal Business Name | CLEAR VISION OPTICAL, INC.
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 677 MT PROSPECT AVENUE
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City | NEWARK
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State | NJ
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Zip | 07104
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Country | US
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Telephone | 973-350-9557
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Fax | 973-350-1051
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Provider Business Mailing Address
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Address Line | 677 MT PROSPECT AVENUE
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City | NEWARK
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State | NJ
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Zip | 07104
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Country | US
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Telephone | 973-350-9557
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Fax | 973-350-1051
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SONIA ELENA ROSARIO
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Credential | OPTICIAN
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Telephone | 973-350-9557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 31TD00348600
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License Number State | NJ
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