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General NPI Number Information
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NPI Number | 1811059785
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Entity Type | Individual
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Provider Name | DIEGO XAVIER MORILLO OD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 875 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07102-2622
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Country | US
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Telephone | 973-622-4492
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Fax | 973-622-5919
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Provider Business Mailing Address
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Address Line | 1386 ALPS RD
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City | WAYNE
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State | NJ
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Zip | 07470-3604
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Country | US
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Telephone | 973-872-6650
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Fax | 201-712-9838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00566203
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License Number State | NJ
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