| NPI | 1558850453 |
|---|---|
| Former Legal Business Name | PAVONIA OPTICAL |
| Entity Type | Organization |
| Authorized Contact | WILLIAM H. CONSTAD Member 201-963-5846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NJ 5463410001) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |