Provider Demographics
NPI:1578968038
Name:THE OPTICAL SHOPPE INC.
Entity Type:Organization
Organization Name:THE OPTICAL SHOPPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-939-5515
Mailing Address - Street 1:700 E CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1455
Mailing Address - Country:US
Mailing Address - Phone:856-393-5515
Mailing Address - Fax:856-939-5541
Practice Address - Street 1:700 E CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1455
Practice Address - Country:US
Practice Address - Phone:856-393-5515
Practice Address - Fax:856-939-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-988332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier