Provider Demographics
NPI:1134361132
Name:OPTOMETRIC ASSOCIATION OF NEWARK
Entity type:Organization
Organization Name:OPTOMETRIC ASSOCIATION OF NEWARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-624-2090
Mailing Address - Street 1:17 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2923
Mailing Address - Country:US
Mailing Address - Phone:973-624-2090
Mailing Address - Fax:973-624-2900
Practice Address - Street 1:17 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2923
Practice Address - Country:US
Practice Address - Phone:973-624-2090
Practice Address - Fax:973-624-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00033900261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3363007Medicaid
NJU70624Medicare UPIN
NJ0172110001Medicare NSC