Provider Demographics
NPI:1306274337
Name:SOUTH FILMORA OPTICAL LLC
Entity type:Organization
Organization Name:SOUTH FILMORA OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-351-6277
Mailing Address - Street 1:1000 SOUTH FILMORA AVE.
Mailing Address - Street 2:SUITE E2
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-351-6277
Mailing Address - Fax:908-351-6338
Practice Address - Street 1:1000 SOUTH FILMORA AVE.
Practice Address - Street 2:SUITE E2
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202
Practice Address - Country:US
Practice Address - Phone:908-351-6277
Practice Address - Fax:908-351-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier