Provider Demographics
NPI:1821204462
Name:CREATIVE VISION CORP.
Entity Type:Organization
Organization Name:CREATIVE VISION CORP.
Other - Org Name:BECKER OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES. OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILHELM
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-399-0909
Mailing Address - Street 1:1068 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-399-0909
Mailing Address - Fax:973-399-8366
Practice Address - Street 1:1068 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-399-0909
Practice Address - Fax:973-399-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1802332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0245120001Medicare ID - Type Unspecified