Organization
JDN VISTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SAMUEL (OPTOMETRIST/OWNER)
(914) 500-3962
Entity
Organization
Contact information
Practice address
200 PROMENADE BLVD, TARGET OPTICAL, BRIDGEWATER, NJ 08807-3456
(732) 357-1168
Mailing address
28 VILLAGE GRN, APT E, BUDD LAKE, NJ 07828-1328
(914) 500-3962
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
27OA006547OO
NJ
Other
Enumeration date
11/30/2016
Last updated
12/02/2016
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