Provider Demographics
NPI:1437376522
Name:FELTON,WONG,WONG & REYNOLDS,PA
Entity Type:Organization
Organization Name:FELTON,WONG,WONG & REYNOLDS,PA
Other - Org Name:THE OPTICAL SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORGENSTERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-683-7994
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-683-7994
Mailing Address - Fax:
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-683-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0449700001Medicare NSC