Provider Demographics
NPI:1881891604
Name:OPTICAL WAVE INC
Entity type:Organization
Organization Name:OPTICAL WAVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-209-2020
Mailing Address - Street 1:286 RT 23
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416
Mailing Address - Country:US
Mailing Address - Phone:973-209-2020
Mailing Address - Fax:973-209-8184
Practice Address - Street 1:286 RT 23
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416
Practice Address - Country:US
Practice Address - Phone:973-209-2020
Practice Address - Fax:973-209-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6817106Medicaid
NJ4399990001Medicare ID - Type Unspecified