Provider Demographics
NPI:1265693188
Name:SOHO OPTICAL LLC
Entity type:Organization
Organization Name:SOHO OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-874-0011
Mailing Address - Street 1:1720 MARLTON PIKE E
Mailing Address - Street 2:SOHO OPTICAL
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2301
Mailing Address - Country:US
Mailing Address - Phone:856-874-0011
Mailing Address - Fax:856-874-0015
Practice Address - Street 1:1720 MARLTON PIKE E
Practice Address - Street 2:SOHO OPTICAL
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2301
Practice Address - Country:US
Practice Address - Phone:856-874-0011
Practice Address - Fax:856-874-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00590600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ131240Medicare PIN
NJV06863Medicare UPIN