Provider Demographics
NPI:1659423952
Name:OPTICAL CONNECTION INC
Entity Type:Organization
Organization Name:OPTICAL CONNECTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAILIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-4400
Mailing Address - Street 1:601 RT 37 WEST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8050
Mailing Address - Country:US
Mailing Address - Phone:732-244-6633
Mailing Address - Fax:732-244-0073
Practice Address - Street 1:601 RT 37 WEST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8050
Practice Address - Country:US
Practice Address - Phone:732-244-6633
Practice Address - Fax:732-244-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0829550001Medicare NSC
NJ0829550001Medicare UPIN