1457400020 NPI number — HOLIDAY OPTICIANS INC

Table of content: (NPI 1457400020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457400020 NPI number — HOLIDAY OPTICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLIDAY OPTICIANS INC
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:
Provider Other Organization Name Type Code:
6
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:
1457400020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 PLAZA DRIVE
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08757-3759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-349-6663
Provider Business Mailing Address Fax Number:
732-349-8803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 PLAZA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08757-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-349-6663
Provider Business Practice Location Address Fax Number:
732-349-8803
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOSSEFF
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-349-6663

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  25MG00033700 , 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: $$$$$$$$$ . This is a "SSN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 178870140 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1788701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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