Provider Demographics
NPI:1467570820
Name:NAZCO OPTICAL LLC
Entity Type:Organization
Organization Name:NAZCO OPTICAL LLC
Other - Org Name:GLEEK AND HOWARD OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:908-353-7374
Mailing Address - Street 1:421 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3612
Mailing Address - Country:US
Mailing Address - Phone:908-353-7374
Mailing Address - Fax:908-353-7106
Practice Address - Street 1:421 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3612
Practice Address - Country:US
Practice Address - Phone:908-353-7374
Practice Address - Fax:908-353-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD2107156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0015113Medicaid
NJ4890640001Medicare ID - Type Unspecified