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NPI Code Detail

MEDICARE: DR. VEENA VERGHESE O.D.

MEDICARE: DR. VEENA VERGHESE O.D.
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
1152W00000XOptometristNJ27OA00695000NJ
2152W00000XOptometrist14576TLGCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OPT 14576OTHERCALICENSE

General Provider Information

NPI Number : 1134479678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VEENA VERGHESE O.D.
Provider Business Mailing Address
First Line : 115 FRANKLIN TPKE
Second Line :
City : MAHWAH
State : NJ
Zip : 07430-1325
Country : US
Telephone Number : 201-684-9000
Fax Number : 201-684-9002
Provider Business Practice Location Address
First Line : 115 FRANKLIN TPKE
Second Line :
City : MAHWAH
State : NJ
Zip : 07430-1325
Country : US
Telephone Number : 201-684-9000
Fax Number : 201-684-9002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2012
Last Update Date : 09/20/2021

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Directions to “ DR. VEENA VERGHESE O.D.” Practice Location

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