Provider Demographics
NPI:1205414448
Name:OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Entity Type:Organization
Organization Name:OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-200-4393
Mailing Address - Street 1:786 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3410
Mailing Address - Country:US
Mailing Address - Phone:732-671-7300
Mailing Address - Fax:732-706-1605
Practice Address - Street 1:3013 HWY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1526
Practice Address - Country:US
Practice Address - Phone:732-739-4000
Practice Address - Fax:732-739-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty