MEDICARE: PINK VISION ASSOCIATES 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
1	152W00000X	Optometrist	27OA00630100	NJ

General Provider Information

NPI Number	:	1417248949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK VISION ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1068 CLINTON AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3501
Country	:	US
Telephone Number	:	973-399-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 CLINTON AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3501
Country	:	US
Telephone Number	:	973-399-0909
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. MARIA DOMINGUES
Credential	:	O.D.
Telephone Number	:	973-399-0909

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	01/23/2013

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Directions to “PINK VISION ASSOCIATES LLC ” Practice Location

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