Provider Demographics
NPI:1649625484
Name:MMA OPTICAL LLC
Entity type:Organization
Organization Name:MMA OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHANNAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINDAKI
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:973-271-4166
Mailing Address - Street 1:47 LAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-1807
Mailing Address - Country:US
Mailing Address - Phone:973-271-4166
Mailing Address - Fax:
Practice Address - Street 1:350 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2702
Practice Address - Country:US
Practice Address - Phone:973-271-4166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00378400332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier