Provider Demographics
NPI:1659568863
Name:LEONARD OPTICAL INC.
Entity Type:Organization
Organization Name:LEONARD OPTICAL INC.
Other - Org Name:BERMAN/ ROSSI EYEGLASSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-721-3770
Mailing Address - Street 1:960 ROUTE 9 SOUTH
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:732-721-3770
Mailing Address - Fax:732-721-3770
Practice Address - Street 1:960 ROUTE 9 SOUTH
Practice Address - Street 2:SUITE 14
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-721-3770
Practice Address - Fax:732-721-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD1110332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1078550001Medicare NSC