Provider Demographics
NPI:1912010240
Name:MRL VISION ASSOCIATES INC
Entity Type:Organization
Organization Name:MRL VISION ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:ULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-736-1700
Mailing Address - Street 1:90 RTE 9
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741
Mailing Address - Country:US
Mailing Address - Phone:732-736-1700
Mailing Address - Fax:732-736-1781
Practice Address - Street 1:90 RTE 9
Practice Address - Street 2:
Practice Address - City:PINE BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08741
Practice Address - Country:US
Practice Address - Phone:732-736-1700
Practice Address - Fax:732-736-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27T00093300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036761Medicare ID - Type Unspecified
U73959Medicare UPIN