MEDICARE: NEWPORT OPTICAL, 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	156FX1800X	Optician	006456	NJ

General Provider Information

NPI Number	:	1427296813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT OPTICAL, LLC

Provider Business Mailing Address
First Line	:	30 MALL DR W
Second Line	:	103A
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-420-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MALL DR W
Second Line	:	103A
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-420-7733
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MICHELLE PINTO
Credential	:
Telephone Number	:	201-420-7733

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	01/23/2009

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Directions to “NEWPORT OPTICAL, LLC ” Practice Location

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