Provider Demographics
NPI:1427296813
Name:NEWPORT OPTICAL, LLC
Entity type:Organization
Organization Name:NEWPORT OPTICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-420-7733
Mailing Address - Street 1:30 MALL DR W
Mailing Address - Street 2:103A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1615
Mailing Address - Country:US
Mailing Address - Phone:201-420-7733
Mailing Address - Fax:
Practice Address - Street 1:30 MALL DR W
Practice Address - Street 2:103A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1615
Practice Address - Country:US
Practice Address - Phone:201-420-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ006456156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty