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General NPI Number Information
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NPI Number | 1760835375
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Entity Type | Organization
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Legal Business Name | EZ.MD.OPTICAL LLC
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 3196 KENNEDY BLVD STE 2
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City | UNION CITY
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State | NJ
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Zip | 07087-2468
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Country | US
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Telephone | 201-628-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 3196 KENNEDY BLVD STE 2
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City | UNION CITY
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State | NJ
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Zip | 07087-2468
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Country | US
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Telephone | 201-628-1465
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Fax |
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Authorized Official
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Title or Position | LIC OPHTHALMIC DISPENSER OPTICIAN
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Name | MR. ROGER R ROMERO SR.
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Credential | 31TD00351400
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Telephone | 201-628-1465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 31TD00351400
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License Number State | NJ
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