Provider Demographics
NPI:1962274563
Name:MOLIS, NORMAN
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:MOLIS
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 1:117 NATRONA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4213
Mailing Address - Country:US
Mailing Address - Phone:609-658-0431
Mailing Address - Fax:609-586-1407
Practice Address - Street 1:1750 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3551
Practice Address - Country:US
Practice Address - Phone:609-438-4091
Practice Address - Fax:609-586-1407
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00222200156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician