Provider Demographics
NPI:1861685596
Name:VERNICKAS, ROBERT ANTHONY (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:VERNICKAS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROUTE 27
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3965
Mailing Address - Country:US
Mailing Address - Phone:732-767-0079
Mailing Address - Fax:732-549-5869
Practice Address - Street 1:7 ROUTE 27
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3965
Practice Address - Country:US
Practice Address - Phone:732-767-0079
Practice Address - Fax:732-549-5869
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD-3021156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4169760001Medicare PIN