Provider Demographics
NPI:1528256898
Name:WILTON OPTICAL, INC
Entity type:Organization
Organization Name:WILTON OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICCARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-837-5599
Mailing Address - Street 1:751 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4242
Mailing Address - Country:US
Mailing Address - Phone:201-837-5599
Mailing Address - Fax:
Practice Address - Street 1:751 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4242
Practice Address - Country:US
Practice Address - Phone:201-837-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTDO1673332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0629890001Medicare NSC