Provider Demographics
NPI:1922183557
Name:BUDD OPTICAL
Entity Type:Organization
Organization Name:BUDD OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:609-953-8700
Mailing Address - Street 1:175 ROUTE 70 STE 23
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2355
Mailing Address - Country:US
Mailing Address - Phone:609-953-8700
Mailing Address - Fax:609-953-2083
Practice Address - Street 1:175 ROUTE 70 STE 23
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2355
Practice Address - Country:US
Practice Address - Phone:609-953-8700
Practice Address - Fax:609-953-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD725332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4574140001Medicare ID - Type Unspecified