Provider Demographics
NPI:1437287109
Name:V. I. OPTICS
Entity type:Organization
Organization Name:V. I. OPTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-852-0500
Mailing Address - Street 1:2045 HIGHWAY 57
Mailing Address - Street 2:MANSFIELD VILLAGE SQUARE
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-852-0500
Mailing Address - Fax:908-813-0628
Practice Address - Street 1:2045 HIGHWAY 57
Practice Address - Street 2:MANSFIELD VILLAGE SQUARE
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-0500
Practice Address - Fax:908-813-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD31TD00209200305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5218840001Medicare ID - Type Unspecified