Provider Demographics
NPI:1861601692
Name:OPTICALVIEWLLC
Entity type:Organization
Organization Name:OPTICALVIEWLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIZONT
Authorized Official - Suffix:
Authorized Official - Credentials:OPTITION
Authorized Official - Phone:732-297-2020
Mailing Address - Street 1:400 RANEISSANCE BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-297-2020
Mailing Address - Fax:
Practice Address - Street 1:400 RANEISSANCE BLVD.
Practice Address - Street 2:NONE
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-297-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3443305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ17102OtherSPECTERA
NJ7869002Medicaid
NJNJ 3443OtherEYEMED
NJ43971OtherDAVIS VISION