Provider Demographics
NPI:1750331799
Name:KOLBER, STUART (OPTOMOTRIST)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:KOLBER
Suffix:
Gender:M
Credentials:OPTOMOTRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 ROUTE 1
Mailing Address - Street 2:STE. 8
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-882-2888
Mailing Address - Fax:
Practice Address - Street 1:2495 ROUTE 1
Practice Address - Street 2:STE. 8
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-882-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00376600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2255201KMedicaid
NJ570618BERMedicare ID - Type Unspecified
NJ2255201KMedicaid