Provider Demographics
NPI:1083070924
Name:STELLAR VISION LLC
Entity Type:Organization
Organization Name:STELLAR VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-735-0377
Mailing Address - Street 1:722 WALL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2237
Mailing Address - Country:US
Mailing Address - Phone:732-735-0377
Mailing Address - Fax:
Practice Address - Street 1:1933 STATE ROUTE 35 STE 120
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3542
Practice Address - Country:US
Practice Address - Phone:732-449-9503
Practice Address - Fax:732-974-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty