Provider Demographics
NPI:1063959856
Name:OPTICIANS OF GLEN ROCK
Entity type:Organization
Organization Name:OPTICIANS OF GLEN ROCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-857-2620
Mailing Address - Street 1:240 ROCK RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1738
Mailing Address - Country:US
Mailing Address - Phone:201-857-2620
Mailing Address - Fax:201-857-2619
Practice Address - Street 1:240 ROCK RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1738
Practice Address - Country:US
Practice Address - Phone:201-857-2620
Practice Address - Fax:201-857-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00355800156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty