Provider Demographics
NPI:1578622270
Name:RJ VISION
Entity Type:Organization
Organization Name:RJ VISION
Other - Org Name:MR. OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-252-1777
Mailing Address - Street 1:275 ROUTE 10 EAST
Mailing Address - Street 2:SUITE 242
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-252-1777
Mailing Address - Fax:973-252-9543
Practice Address - Street 1:275 ROUTE 10 EAST
Practice Address - Street 2:SUITE 242
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-252-1777
Practice Address - Fax:973-252-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00550300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7452004Medicaid
NJU68707Medicare UPIN
NJ7452004Medicaid