Provider Demographics
NPI:1003003179
Name:B & K OPTICAL
Entity Type:Organization
Organization Name:B & K OPTICAL
Other - Org Name:EYESFIRST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-940-0900
Mailing Address - Street 1:3391 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1358
Mailing Address - Country:US
Mailing Address - Phone:732-940-0900
Mailing Address - Fax:
Practice Address - Street 1:3391 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1358
Practice Address - Country:US
Practice Address - Phone:732-940-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00189301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0953900001Medicare NSC