Provider Demographics
NPI:1093989626
Name:FOKAS VISION CORPORATION -SALLY FOKAS
Entity Type:Organization
Organization Name:FOKAS VISION CORPORATION -SALLY FOKAS
Other - Org Name:TESTA OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-744-9041
Mailing Address - Street 1:547 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1880
Mailing Address - Country:US
Mailing Address - Phone:973-744-9041
Mailing Address - Fax:973-744-4907
Practice Address - Street 1:547 VALLEY RD
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1880
Practice Address - Country:US
Practice Address - Phone:973-744-9041
Practice Address - Fax:973-744-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00218900332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5665290001Medicare NSC