Provider Demographics
NPI:1780973834
Name:ROMERO, ROGER R SR (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:R
Last Name:ROMERO
Suffix:SR
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:MR
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LICENCED OPTICIAN
Mailing Address - Street 1:3196 KENNEDY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2468
Mailing Address - Country:US
Mailing Address - Phone:201-863-9013
Mailing Address - Fax:201-863-8431
Practice Address - Street 1:3196 KENNEDY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2468
Practice Address - Country:US
Practice Address - Phone:201-863-9013
Practice Address - Fax:201-863-8431
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00351400156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic