MEDICARE: JMH OPTICAL

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	156FX1800X	Optician	31TD00362300	NJ
2	156FX1100X	Ophthalmic Technician/Technologist	31TD00362300	NJ

General Provider Information

NPI Number	:	1366778458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMH OPTICAL

Provider Business Mailing Address
First Line	:	1 GARDEN STATE PLZ
Second Line	:	T13A
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2417
Country	:	US
Telephone Number	:	201-587-0122
Fax Number	:	201-587-1301

Provider Business Practice Location Address
First Line	:	1 GARDEN STATE PLZ
Second Line	:	T13A
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2417
Country	:	US
Telephone Number	:	201-587-0122
Fax Number	:	201-587-1301

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. JOHN M HANNA
Credential	:
Telephone Number	:	201-587-0122

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	10/23/2009

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Directions to “JMH OPTICAL ” Practice Location

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