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NPI Code Detail

MEDICARE: FORT LEE VISION LLC

MEDICARE: FORT LEE VISION LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier27OA00602800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003144833
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT LEE VISION LLC
Provider Business Mailing Address
First Line : 2151 LEMOINE AVE
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6041
Country : US
Telephone Number : 201-346-9000
Fax Number : 201-346-9001
Provider Business Practice Location Address
First Line : 2151 LEMOINE AVE
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6041
Country : US
Telephone Number : 201-346-9000
Fax Number : 201-346-9001
Authorized Official
Title or Position : O.D./OWNER
Name : DR. DIANE M. KIM
Credential : O.D.
Telephone Number : 201-346-9000
Provider Enumeration Date : 12/07/2009
Last Update Date : 12/11/2014

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Directions to “FORT LEE VISION LLC ” Practice Location

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