Provider Demographics
NPI:1487987244
Name:MD OPTICAL & VITAMINS, LLC.
Entity type:Organization
Organization Name:MD OPTICAL & VITAMINS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RISHIPAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-604-4487
Mailing Address - Street 1:1115 INMAN AVE
Mailing Address - Street 2:SUITE 365.,
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1132
Mailing Address - Country:US
Mailing Address - Phone:732-604-4487
Mailing Address - Fax:732-543-2603
Practice Address - Street 1:1115 INMAN AVE
Practice Address - Street 2:SUITE 365.,
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1132
Practice Address - Country:US
Practice Address - Phone:732-604-4487
Practice Address - Fax:732-543-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00351400156FX1800X
NJ25MA02048600156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty