Provider Demographics
NPI:1306996558
Name:NORTHERN VALLEY OPTICIANS,INC
Entity type:Organization
Organization Name:NORTHERN VALLEY OPTICIANS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-767-7988
Mailing Address - Street 1:113 VERVALEN ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2612
Mailing Address - Country:US
Mailing Address - Phone:201-767-7988
Mailing Address - Fax:201-767-1337
Practice Address - Street 1:113 VERVALEN ST
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2612
Practice Address - Country:US
Practice Address - Phone:201-767-7988
Practice Address - Fax:201-767-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD872156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0770510001Medicare PIN