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General NPI Number Information
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NPI Number | 1780950204
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Entity Type | Organization
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Legal Business Name | VUTT
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 37 WEST ROUTE 130 SOUTH
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City | BURLINGTON
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State | NJ
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Zip | 08016
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Country | US
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Telephone | 609-747-0070
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Fax | 609-747-0782
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Provider Business Mailing Address
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Address Line | 37 WEST ROUTE 130 SOUTH
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City | BURLINGTON
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State | NJ
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Zip | 08016
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Country | US
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Telephone | 609-747-0070
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Fax | 609-747-0782
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Authorized Official
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Title or Position | LICENSED OPTICIAN
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Name | MR. PAUL M LUCCA
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Credential | TD3816
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Telephone | 609-747-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | TD3816
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TD3816
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License Number State | NJ
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