Provider Demographics
NPI:1376860601
Name:ELEGANT OPTICAL LLC
Entity Type:Organization
Organization Name:ELEGANT OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:UTENZI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-755-2500
Mailing Address - Street 1:211 W FRONT ST
Mailing Address - Street 2:114
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1107
Mailing Address - Country:US
Mailing Address - Phone:908-755-2500
Mailing Address - Fax:908-755-2507
Practice Address - Street 1:211 W FRONT ST
Practice Address - Street 2:114
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1107
Practice Address - Country:US
Practice Address - Phone:908-755-2500
Practice Address - Fax:908-755-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3287156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty