Provider Demographics
NPI:1912140757
Name:COVENTRY OPTICAL, P.C.
Entity Type:Organization
Organization Name:COVENTRY OPTICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-859-6055
Mailing Address - Street 1:800 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1973
Mailing Address - Country:US
Mailing Address - Phone:908-454-4858
Mailing Address - Fax:
Practice Address - Street 1:10 BRASS CASTLE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-6309
Practice Address - Country:US
Practice Address - Phone:908-835-2697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00313203332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier