Provider Demographics
NPI:1942438825
Name:CRYSTAL WORLD
Entity Type:Organization
Organization Name:CRYSTAL WORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HESSELL
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:201-488-0909
Mailing Address - Street 1:89 LEUNING ST
Mailing Address - Street 2:A2
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-1345
Mailing Address - Country:US
Mailing Address - Phone:201-488-0909
Mailing Address - Fax:201-488-7447
Practice Address - Street 1:89 LEUNING ST
Practice Address - Street 2:A2
Practice Address - City:SOUTH HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07606-1345
Practice Address - Country:US
Practice Address - Phone:201-488-0909
Practice Address - Fax:201-488-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00367800156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty