Provider Demographics
NPI:1073721817
Name:BROADWAY VISION SERVICES INC.
Entity Type:Organization
Organization Name:BROADWAY VISION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWENDU
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUKWUEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-268-2565
Mailing Address - Street 1:59 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2503
Mailing Address - Country:US
Mailing Address - Phone:972-268-2565
Mailing Address - Fax:973-484-3868
Practice Address - Street 1:59 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2503
Practice Address - Country:US
Practice Address - Phone:972-268-2565
Practice Address - Fax:973-484-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00509100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty