Provider Demographics
NPI:1851457600
Name:D'OLIVEIRA, JOSEEPH (OWNER)
Entity Type:Individual
Prefix:
First Name:JOSEEPH
Middle Name:
Last Name:D'OLIVEIRA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2211
Mailing Address - Country:US
Mailing Address - Phone:908-351-6277
Mailing Address - Fax:908-351-6338
Practice Address - Street 1:1167 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2211
Practice Address - Country:US
Practice Address - Phone:908-351-6277
Practice Address - Fax:908-351-6338
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00253100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ2531OtherEYEMED
NJ6053203Medicaid
NJ6801OtherDAVIS VISISON