Individual
MR. KEVIN DONALD KOOISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1033 CLIFTON AVE, SUITE 107, CLIFTON, NJ 07013-3517
(973) 471-1225
(973) 472-4835
Mailing address
1033 CLIFTON AVE, SUITE 107, CLIFTON, NJ 07013-3517
(973) 471-1225
(973) 472-4835
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
31TD00190700
NJ
Other
Enumeration date
11/21/2006
Last updated
10/26/2011
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