Provider Demographics
NPI:1568904548
Name:WYCKOFF OPTICAL, INC.
Entity Type:Organization
Organization Name:WYCKOFF OPTICAL, INC.
Other - Org Name:JAMES TRACEY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-560-1000
Mailing Address - Street 1:400 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1347
Mailing Address - Country:US
Mailing Address - Phone:201-560-1000
Mailing Address - Fax:201-560-0573
Practice Address - Street 1:400 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1347
Practice Address - Country:US
Practice Address - Phone:201-560-1000
Practice Address - Fax:201-560-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00544400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty