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General NPI Number Information
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NPI Number | 1750002069
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Entity Type | Organization
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Legal Business Name | MODERN VUE EYECARE
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 1508 WILLOWBROOK MALL
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City | WAYNE
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State | NJ
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Zip | 07470
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Country | US
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Telephone | 973-256-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 23 HOPPER LN
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City | WAYNE
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State | NJ
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Zip | 07470-4656
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Country | US
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Telephone | 706-631-7168
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MARIAM ASLAMI
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Credential | OD
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Telephone | 706-631-7168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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