Provider Demographics
NPI:1730217365
Name:ANGRIST OPTICAL LLC
Entity type:Organization
Organization Name:ANGRIST OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANGRIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-246-1050
Mailing Address - Street 1:1527 STATE ROUTE 27
Mailing Address - Street 2:STE 2600
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3979
Mailing Address - Country:US
Mailing Address - Phone:732-246-1050
Mailing Address - Fax:
Practice Address - Street 1:1527 STATE ROUTE 27
Practice Address - Street 2:STE 2600
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3979
Practice Address - Country:US
Practice Address - Phone:732-246-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD C.ANGRIST, M.D.,P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04389500332H00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095500076OtherVISION SERVICE PLAN VSP
NJ1293550001Medicare NSC