MEDICARE: OPTOMETRIC PHYSICIANS OF HAZLET, PA

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		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629071295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRIC PHYSICIANS OF HAZLET, PA

Provider Business Mailing Address
First Line	:	3013 HWY 35
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1526
Country	:	US
Telephone Number	:	732-739-4000
Fax Number	:	732-739-4002

Provider Business Practice Location Address
First Line	:	3013 HWY 35
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1526
Country	:	US
Telephone Number	:	732-739-4000
Fax Number	:	732-739-4002

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. TODD HOWARD GERSHENOW
Credential	:	OD
Telephone Number	:	732-739-4000

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/21/2022

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Directions to “OPTOMETRIC PHYSICIANS OF HAZLET, PA ” Practice Location

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