Provider Demographics
NPI:1518162452
Name:WYSSLING-GREEN, EVAMARIA (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:EVAMARIA
Middle Name:
Last Name:WYSSLING-GREEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MRS
Other - First Name:EVAMARIA
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:119 BOONTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1427
Mailing Address - Country:US
Mailing Address - Phone:973-230-1717
Mailing Address - Fax:973-230-1715
Practice Address - Street 1:119 BOONTON AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1427
Practice Address - Country:US
Practice Address - Phone:973-230-1717
Practice Address - Fax:973-230-1715
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00188200156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician