MEDICARE: OPTICAL PALACE OF HARRISON 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	TD3405	NJ

General Provider Information

NPI Number	:	1700957503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL PALACE OF HARRISON LLC

Provider Business Mailing Address
First Line	:	1053 SPRINGFIELD AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2408
Country	:	US
Telephone Number	:	973-416-6664
Fax Number	:	973-416-6649

Provider Business Practice Location Address
First Line	:	1053 SPRINGFIELD AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2408
Country	:	US
Telephone Number	:	973-416-6664
Fax Number	:	973-416-6649

Authorized Official
Title or Position	:	MEMBER OF LLC
Name	:	PARAG RAITHATHA
Credential	:
Telephone Number	:	973-416-6664

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/01/2026

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