Provider Demographics
NPI:1306137674
Name:OPTICAL CONNECTION INCORPORATED
Entity type:Organization
Organization Name:OPTICAL CONNECTION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAILIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-4400
Mailing Address - Street 1:615 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2200
Mailing Address - Country:US
Mailing Address - Phone:609-693-8555
Mailing Address - Fax:609-693-4518
Practice Address - Street 1:615 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2200
Practice Address - Country:US
Practice Address - Phone:609-693-8555
Practice Address - Fax:609-693-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0829550001Medicare UPIN