Provider Demographics
NPI:1861660508
Name:MANCINE OPTICAL COMPANY
Entity Type:Organization
Organization Name:MANCINE OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANCINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-764-0200
Mailing Address - Street 1:2910 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2522
Mailing Address - Country:US
Mailing Address - Phone:856-764-0200
Mailing Address - Fax:856-764-1414
Practice Address - Street 1:2910 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2522
Practice Address - Country:US
Practice Address - Phone:856-764-0200
Practice Address - Fax:856-764-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1048156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0671790001Medicare NSC