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General NPI Number Information
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NPI Number | 1750053450
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Entity Type | Organization
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Legal Business Name | SNS VISION
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 204 HADDON AVE
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City | WEST BERLIN
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State | NJ
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Zip | 08091-1607
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Country | US
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Telephone | 856-768-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 416 JACKSON AVE
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1924
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Country | US
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Telephone | 917-520-3092
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SARA SHISSIAS
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Credential | OD
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Telephone | 917-520-3092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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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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