MEDICARE: MR. ROBERT CHARLES MICHNOFF

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	D1625	NJ

General Provider Information

NPI Number	:	1528253358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CHARLES MICHNOFF

Provider Business Mailing Address
First Line	:	6 WEST SPRUCE STREET
Second Line	:	VISION EYEWEAR
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5007
Country	:	US
Telephone Number	:	732-364-1771
Fax Number	:	732-364-1772

Provider Business Practice Location Address
First Line	:	6 WEST SPRUCE STREET
Second Line	:	VISION EYEWEAR
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5007
Country	:	US
Telephone Number	:	732-364-1771
Fax Number	:	732-364-1772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	06/30/2008

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