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General NPI Number Information
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NPI Number | 1861283624
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Entity Type | Organization
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Legal Business Name | MY OPTOMETRY GROUP PC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 174 PASSAIC ST
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City | GARFIELD
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State | NJ
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Zip | 07026-1358
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Country | US
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Telephone | 973-330-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 234 KNOX AVE UNIT B
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-2510
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Country | US
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Telephone | 201-421-9319
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Fax | 201-945-3470
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN SUNG KIM
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Credential | OD
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Telephone | 201-421-9319
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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 |
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License Number State |
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