Provider Demographics
NPI:1376890459
Name:BELLO, LAURA ALEJANDRA (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ALEJANDRA
Last Name:BELLO
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 JOHANNA CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8509
Mailing Address - Country:US
Mailing Address - Phone:856-823-4393
Mailing Address - Fax:
Practice Address - Street 1:1413 JOHANNA CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8509
Practice Address - Country:US
Practice Address - Phone:856-823-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ#TD3650156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier