Provider Demographics
NPI:1053609305
Name:OPTI EYE CARE
Entity type:Organization
Organization Name:OPTI EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-357-8357
Mailing Address - Street 1:140 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1023
Mailing Address - Country:US
Mailing Address - Phone:973-357-8357
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1023
Practice Address - Country:US
Practice Address - Phone:973-357-8357
Practice Address - Fax:973-357-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00601300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0254975Medicaid