Provider Demographics
NPI:1972226850
Name:RAIA, CAITLYN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:ELIZABETH
Last Name:RAIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 W MAIN ST APT 123
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2221
Mailing Address - Country:US
Mailing Address - Phone:908-872-5998
Mailing Address - Fax:
Practice Address - Street 1:571 CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-312-7003
Practice Address - Fax:908-464-4737
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00716300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist