Provider Demographics
NPI:1083771109
Name:VELAZQUEZ, CHRISTOPHER (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ROSE TER
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2127
Mailing Address - Country:US
Mailing Address - Phone:973-857-1410
Mailing Address - Fax:
Practice Address - Street 1:CHRISTOPHER VELAZQUEZ NOBEL EYEGLASSES
Practice Address - Street 2:701 ROUTE 440 ( INSIDE HUDSON MALL )
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-433-5080
Practice Address - Fax:201-435-1101
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00083700156FX1800X
NY00003468156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician