1578622270 NPI number — RJ VISION

Table of content: (NPI 1578622270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578622270 NPI number — RJ VISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RJ VISION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MR. OPTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578622270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 ROUTE 10 EAST
Provider Second Line Business Mailing Address:
SUITE 242
Provider Business Mailing Address City Name:
SUCCASUNNA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-252-1777
Provider Business Mailing Address Fax Number:
973-252-9543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 ROUTE 10 EAST
Provider Second Line Business Practice Location Address:
SUITE 242
Provider Business Practice Location Address City Name:
SUCCASUNNA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-252-1777
Provider Business Practice Location Address Fax Number:
973-252-9543
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
KYUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-252-1777

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00550300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7452004 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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