Provider Demographics
NPI:1588716187
Name:OPTICAL CENTER OAKRIDGE LLC
Entity type:Organization
Organization Name:OPTICAL CENTER OAKRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-383-3650
Mailing Address - Street 1:5746 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9847
Mailing Address - Country:US
Mailing Address - Phone:973-697-4550
Mailing Address - Fax:973-697-4548
Practice Address - Street 1:5746 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9847
Practice Address - Country:US
Practice Address - Phone:973-697-4550
Practice Address - Fax:973-697-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1663156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ313225OtherN.V.A.
NJ881OtherVISION SCREENING
NJ117249OtherEYEMED
NJ0660950001Medicare ID - Type Unspecified