Provider Demographics
NPI:1376831131
Name:POLLACK, DANA BETH (OD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BETH
Last Name:POLLACK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:BETH
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1120 TOWN CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-992-2002
Mailing Address - Fax:973-992-3803
Practice Address - Street 1:1120 TOWN CENTER WAY
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-992-2002
Practice Address - Fax:973-992-3803
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007730152W00000X
NJ27OA00653900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist