Provider Demographics
NPI:1780950204
Name:VUTT
Entity type:Organization
Organization Name:VUTT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:TD3816
Authorized Official - Phone:609-747-0070
Mailing Address - Street 1:37 WEST ROUTE 130 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:609-747-0070
Mailing Address - Fax:609-747-0782
Practice Address - Street 1:37 WEST ROUTE 130 SOUTH
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-747-0070
Practice Address - Fax:609-747-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD3816332BC3200X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment