Provider Demographics
NPI:1710168513
Name:PD OPTICS INC
Entity Type:Organization
Organization Name:PD OPTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:973-338-1717
Mailing Address - Street 1:1083 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2918
Mailing Address - Country:US
Mailing Address - Phone:973-338-1717
Mailing Address - Fax:973-338-1717
Practice Address - Street 1:1083 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2918
Practice Address - Country:US
Practice Address - Phone:973-338-1717
Practice Address - Fax:973-338-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD3037332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5302390001Medicare NSC