Provider Demographics
NPI:1548975030
Name:WOODCLIFF LAKE OPTICAL LLC
Entity type:Organization
Organization Name:WOODCLIFF LAKE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YASHAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-782-1700
Mailing Address - Street 1:577 CHESTNUT RIDGE RD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:577 CHESTNUT RIDGE RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8409
Practice Address - Country:US
Practice Address - Phone:201-782-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty