Individual
DAVID IOSEBASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
766 BLOOMFIELD AVE., WEST CALDWELL, NJ 07006
(973) 882-1967
(973) 882-5553
Mailing address
766 BLOOMFIELD AVE., WEST CALDWELL, NJ 07006
(973) 882-1967
(973) 882-5553
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
27OA 00592800
NJ
152W00000X
Optometrist
TUV 006788
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3973690
AETNA ID NUMBER
NJ
Enumeration date
08/11/2006
Last updated
07/09/2007
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