Provider Demographics
NPI:1043387178
Name:TRUWAY VISION CARE PA
Entity Type:Organization
Organization Name:TRUWAY VISION CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLAMARIA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:KORIEOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-673-5773
Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3607
Mailing Address - Country:US
Mailing Address - Phone:973-673-5773
Mailing Address - Fax:973-673-5794
Practice Address - Street 1:311 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3607
Practice Address - Country:US
Practice Address - Phone:973-673-5773
Practice Address - Fax:973-673-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00549800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7455801Medicaid
NJ087102Medicare PIN
NJ7455801Medicaid