Provider Demographics
NPI:1124246202
Name:FOKAS, SALLY ANN (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:FOKAS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1880
Mailing Address - Country:US
Mailing Address - Phone:973-744-9041
Mailing Address - Fax:973-744-4907
Practice Address - Street 1:547 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1880
Practice Address - Country:US
Practice Address - Phone:973-744-9041
Practice Address - Fax:973-744-4907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD2189156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5665290001Medicare NSC