Provider Demographics
NPI:1942698717
Name:MENA, VITTORIO JR (OD)
Entity Type:Individual
Prefix:DR
First Name:VITTORIO
Middle Name:
Last Name:MENA
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2146
Mailing Address - Country:US
Mailing Address - Phone:201-945-2525
Mailing Address - Fax:
Practice Address - Street 1:31 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1711
Practice Address - Country:US
Practice Address - Phone:201-939-2463
Practice Address - Fax:201-939-1454
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00657300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management