Provider Demographics
NPI:1861751448
Name:CRYSTAL LENS OPTICAL OF PASSAIC LLC
Entity type:Organization
Organization Name:CRYSTAL LENS OPTICAL OF PASSAIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAYED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-2020
Mailing Address - Street 1:670 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5115
Mailing Address - Country:US
Mailing Address - Phone:973-773-2020
Mailing Address - Fax:972-773-2011
Practice Address - Street 1:670 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5115
Practice Address - Country:US
Practice Address - Phone:973-773-2020
Practice Address - Fax:972-773-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier