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NPI Code Detail

MEDICARE: MGM OPTICIANS INC

MEDICARE: MGM OPTICIANS INC
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
1156FX1800XOptician31TD00151100NJ

General Provider Information

NPI Number : 1689731721
Entity Type Code : Organization
Provider Name (Legal Business Name) : MGM OPTICIANS INC
Provider Business Mailing Address
First Line : 345 UNION HILL RD
Second Line :
City : MANALAPAN
State : NJ
Zip : 07726-1875
Country : US
Telephone Number : 732-536-0460
Fax Number : 732-536-0421
Provider Business Practice Location Address
First Line : 345 UNION HILL RD
Second Line :
City : MANALAPAN
State : NJ
Zip : 07726-1875
Country : US
Telephone Number : 732-536-0460
Fax Number : 732-536-0421
Authorized Official
Title or Position : PRESIDENT
Name : MR. MARC DANIEL GOOTMAN
Credential :
Telephone Number : 732-536-0460
Provider Enumeration Date : 01/01/2007
Last Update Date : 01/13/2009

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Directions to “MGM OPTICIANS INC ” Practice Location

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