Provider Demographics
NPI:1952500647
Name:OPTIQUE EYEWEAR
Entity Type:Organization
Organization Name:OPTIQUE EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:D'ALBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-659-2020
Mailing Address - Street 1:1126 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5302
Mailing Address - Country:US
Mailing Address - Phone:201-659-2020
Mailing Address - Fax:201-659-8330
Practice Address - Street 1:1126 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5302
Practice Address - Country:US
Practice Address - Phone:201-659-2020
Practice Address - Fax:201-659-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37684332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1253107Medicaid
NJD96920Medicare UPIN