MEDICARE: MANCHESTER BRICK VISION CENTER

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
1	152W00000X	Optometrist	NJ5293	NJ

General Provider Information

NPI Number	:	1184779688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHESTER BRICK VISION CENTER

Provider Business Mailing Address
First Line	:	359 BRICK BLVD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6010
Country	:	US
Telephone Number	:	732-920-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 BRICK BLVD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6010
Country	:	US
Telephone Number	:	732-920-1330
Fax Number	:

Authorized Official
Title or Position	:	MS.
Name	:	MARIE SMITH
Credential	:
Telephone Number	:	732-920-1330

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	01/16/2008

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