Provider Demographics
NPI:1326613571
Name:CRYSTAL LENS OPTICAL LLC
Entity Type:Organization
Organization Name:CRYSTAL LENS OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORSZT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-773-2020
Mailing Address - Street 1:CRYSTAL LENS OPTICAL LLC
Mailing Address - Street 2:670 MAIN AVE
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5171
Mailing Address - Country:US
Mailing Address - Phone:973-773-2020
Mailing Address - Fax:973-773-2011
Practice Address - Street 1:CRYSTAL LENS OPTICAL LLC
Practice Address - Street 2:670 MAIN AVE
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5171
Practice Address - Country:US
Practice Address - Phone:973-773-2020
Practice Address - Fax:973-773-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty