Provider Demographics
NPI:1477863686
Name:EDISON OPTOMERIC
Entity Type:Organization
Organization Name:EDISON OPTOMERIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SICA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-738-1666
Mailing Address - Street 1:940 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2869
Mailing Address - Country:US
Mailing Address - Phone:732-738-1666
Mailing Address - Fax:732-738-8132
Practice Address - Street 1:940 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2869
Practice Address - Country:US
Practice Address - Phone:732-738-1666
Practice Address - Fax:732-738-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty