Provider Demographics
NPI:1356664700
Name:MYRON BLOCH OD PC
Entity Type:Organization
Organization Name:MYRON BLOCH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:I
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD,PC
Authorized Official - Phone:973-278-4480
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1201
Mailing Address - Country:US
Mailing Address - Phone:973-278-4480
Mailing Address - Fax:973-278-6003
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1201
Practice Address - Country:US
Practice Address - Phone:973-278-4480
Practice Address - Fax:973-278-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00351800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4572106Medicaid