Provider Demographics
NPI:1528253358
Name:MICHNOFF, ROBERT CHARLES
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:MICHNOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WEST SPRUCE STREET
Mailing Address - Street 2:VISION EYEWEAR
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5007
Mailing Address - Country:US
Mailing Address - Phone:732-364-1771
Mailing Address - Fax:732-364-1772
Practice Address - Street 1:6 WEST SPRUCE STREET
Practice Address - Street 2:VISION EYEWEAR
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5007
Practice Address - Country:US
Practice Address - Phone:732-364-1771
Practice Address - Fax:732-364-1772
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1625156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6051970001Medicare NSC
NJ0679550001Medicare PIN