Organization
NORTHWEST OPTOMETRY GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD MULLIN O.D. (V.P.)
(908) 832-9211
Entity
Organization
Contact information
Practice address
117 SPARTA AVE, SPARTA, NJ 07871-1773
(973) 729-9199
(973) 729-9260
Mailing address
117 SPARTA AVE, SPARTA, NJ 07871-1773
(973) 729-9199
(973) 729-9260
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331420102
—
NJ
05
—
331420103
—
NJ
05
—
331420104
—
NJ
05
—
331420105
—
NJ
05
—
331420106
—
NJ
01
—
CD9470
RAILROAD MEDICARE
—
Enumeration date
04/28/2006
Last updated
09/23/2013
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