Provider Demographics
NPI:1376539940
Name:IORIO, TINA L (OD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:IORIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PROFESSIONAL CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2428
Mailing Address - Country:US
Mailing Address - Phone:932-780-0605
Mailing Address - Fax:732-780-0961
Practice Address - Street 1:5 PROFESSIONAL CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2428
Practice Address - Country:US
Practice Address - Phone:932-780-0605
Practice Address - Fax:732-780-0961
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00563100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94301Medicare UPIN
NJ067976Medicare ID - Type Unspecified