Provider Demographics
NPI:1245404631
Name:SUBURBAN OPTIK, INC
Entity Type:Organization
Organization Name:SUBURBAN OPTIK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-464-3322
Mailing Address - Street 1:369 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1170
Mailing Address - Country:US
Mailing Address - Phone:908-464-3322
Mailing Address - Fax:908-665-2936
Practice Address - Street 1:369 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1170
Practice Address - Country:US
Practice Address - Phone:908-464-3322
Practice Address - Fax:908-665-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00136300332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0185980001Medicare NSC