Provider Demographics
NPI:1821361379
Name:OPTICAL CONNECTION INC
Entity Type:Organization
Organization Name:OPTICAL CONNECTION INC
Other - Org Name:OPTICAL CONNECTION, III
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING MANAGER, DO
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-4400
Mailing Address - Street 1:601 ROUTE 37 W
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:732-244-4400
Mailing Address - Fax:732-505-2171
Practice Address - Street 1:108 LACEY RD, SUITE 34
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1337
Practice Address - Country:US
Practice Address - Phone:732-350-0002
Practice Address - Fax:732-350-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0829550001Medicare UPIN