Provider Demographics
NPI:1639377039
Name:LITTLE FERRY OPTICAL
Entity Type:Organization
Organization Name:LITTLE FERRY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-641-2030
Mailing Address - Street 1:260 BERGEN TPKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1104
Mailing Address - Country:US
Mailing Address - Phone:201-641-2030
Mailing Address - Fax:201-641-7706
Practice Address - Street 1:260 BERGEN TURNPIKE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643
Practice Address - Country:US
Practice Address - Phone:201-641-2030
Practice Address - Fax:201-641-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8912203Medicaid