Individual
MR. PETER A. GOETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
134 MAIN ST, MANASQUAN, NJ 08736-3558
(732) 223-2020
Mailing address
134 MAIN ST, MANASQUAN, NJ 08736-3558
(732) 223-2020
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
31TD00185200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2222259035
TAX ID
NJ
05
—
7425406
—
NJ
Enumeration date
03/19/2007
Last updated
07/08/2007
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