Provider Demographics
NPI:1679627244
Name:RSJ OPTICAL INC
Entity type:Organization
Organization Name:RSJ OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTROLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-449-5902
Mailing Address - Street 1:1933 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3502
Mailing Address - Country:US
Mailing Address - Phone:732-449-9503
Mailing Address - Fax:732-974-7120
Practice Address - Street 1:1933 ROUTE 35
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3502
Practice Address - Country:US
Practice Address - Phone:732-449-9503
Practice Address - Fax:732-974-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDME 077-282-0001Medicare UPIN
NJ0772820001Medicare NSC