Provider Demographics
NPI:1255445839
Name:PRECISION OPTICAL, LLC
Entity type:Organization
Organization Name:PRECISION OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-289-0250
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-289-0250
Mailing Address - Fax:908-289-3713
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 505
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-289-0250
Practice Address - Fax:908-289-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1294450001Medicare NSC