Provider Demographics
NPI:1164600664
Name:PETER J CETTA
Entity Type:Organization
Organization Name:PETER J CETTA
Other - Org Name:FREEDOM OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-895-4600
Mailing Address - Street 1:10 WEST HANOVER AVE
Mailing Address - Street 2:FREEDOM OPTICAL
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4221
Mailing Address - Country:US
Mailing Address - Phone:973-895-4600
Mailing Address - Fax:973-895-4604
Practice Address - Street 1:10 WEST HANOVER AVE
Practice Address - Street 2:FREEDOM OPTICAL
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4221
Practice Address - Country:US
Practice Address - Phone:973-895-4600
Practice Address - Fax:973-895-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00215800156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0839480001Medicare NSC