Provider Demographics
NPI:1639246788
Name:GARITA VISION CENTER, LLC
Entity Type:Organization
Organization Name:GARITA VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ GARITA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-868-1886
Mailing Address - Street 1:7418 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5449
Mailing Address - Country:US
Mailing Address - Phone:201-868-1886
Mailing Address - Fax:201-868-7392
Practice Address - Street 1:7418 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5449
Practice Address - Country:US
Practice Address - Phone:201-868-1886
Practice Address - Fax:201-868-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ786552Medicare ID - Type Unspecified
NJU56800Medicare UPIN