Provider Demographics
NPI:1992803605
Name:CERVONE, ANGELO A (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:A
Last Name:CERVONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07851-0173
Mailing Address - Country:US
Mailing Address - Phone:973-670-1523
Mailing Address - Fax:
Practice Address - Street 1:128 WATER ST
Practice Address - Street 2:THE OPTICAL CENTER
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1415
Practice Address - Country:US
Practice Address - Phone:973-383-7410
Practice Address - Fax:973-383-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ05397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist