Provider Demographics
NPI:1497916928
Name:LINWOOD OPTICAL
Entity Type:Organization
Organization Name:LINWOOD OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHTHALMOLIGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:REMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-653-2080
Mailing Address - Street 1:2020 NEW RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1039
Mailing Address - Country:US
Mailing Address - Phone:609-653-2080
Mailing Address - Fax:
Practice Address - Street 1:2020 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1039
Practice Address - Country:US
Practice Address - Phone:609-653-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1328332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ903920101Medicaid
NJ903920101Medicaid