Provider Demographics
NPI:1992743983
Name:SPIV OPTICS, INC
Entity type:Organization
Organization Name:SPIV OPTICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SPIVACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-875-8989
Mailing Address - Street 1:3501 ROUTE 42
Mailing Address - Street 2:UNIT 360
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1752
Mailing Address - Country:US
Mailing Address - Phone:856-875-8989
Mailing Address - Fax:856-875-6978
Practice Address - Street 1:3501 ROUTE 42
Practice Address - Street 2:UNIT 360
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1752
Practice Address - Country:US
Practice Address - Phone:856-875-8989
Practice Address - Fax:856-875-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0145460001Medicare NSC
NJT30124Medicare UPIN
NJ218246Medicare PIN