Provider Demographics
NPI:1558064386
Name:OPTIC ONE INC
Entity Type:Organization
Organization Name:OPTIC ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-786-1616
Mailing Address - Street 1:4423 ROUTE 130 S
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2385
Mailing Address - Country:US
Mailing Address - Phone:609-386-0202
Mailing Address - Fax:609-386-5927
Practice Address - Street 1:2401 ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3020
Practice Address - Country:US
Practice Address - Phone:856-786-1616
Practice Address - Fax:856-786-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty