Provider Demographics
NPI:1417003872
Name:NAYLOR, ROGER WILLIAM (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WILLIAM
Last Name:NAYLOR
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 LACEY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-0724
Mailing Address - Country:US
Mailing Address - Phone:609-693-3944
Mailing Address - Fax:609-971-0265
Practice Address - Street 1:442 LACEY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-0724
Practice Address - Country:US
Practice Address - Phone:609-693-3944
Practice Address - Fax:609-971-0265
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1092156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOK9821OtherNJ HEALTH NET
NJOK9821OtherNJ HEALTH NET