Organization
OPTICAL BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KARINA MANUKYAN (OPTICIAN/OWNER)
(732) 246-6895
Entity
Organization
Contact information
Practice address
1 SPRING ST, UNIT 101, NEW BRUNSWICK, NJ 08901-2276
(732) 246-6895
Mailing address
1 SPRING STREET, UNIT 101, NEW BRUNSWICK, NJ 08901-2036
(732) 246-6895
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
270A00552600
NJ
156FX1800X
Optician
Primary
31TD00317100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0165441
—
NJ
Enumeration date
06/27/2008
Last updated
02/07/2014
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