Provider Demographics
NPI:1023643079
Name:LENS LAB EXPRESS OF 5917 BERGENLINE
Entity type:Organization
Organization Name:LENS LAB EXPRESS OF 5917 BERGENLINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-861-0016
Mailing Address - Street 1:5917 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1306
Mailing Address - Country:US
Mailing Address - Phone:201-861-0016
Mailing Address - Fax:201-861-7303
Practice Address - Street 1:5917 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1306
Practice Address - Country:US
Practice Address - Phone:201-861-0016
Practice Address - Fax:201-861-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty