| Super Vision Llc | |
|
461 Central Ave, Jersey City, NJ 07307-2740 | |
| (201) 420-0101 | |
| (201) 420-1123 |
| Full Name | Super Vision Llc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 461 Central Ave, Jersey City, New Jersey |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295038552 | NPI | - | NPPES |
| 2Y1165 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 27OA00615400 (New Jersey) | Primary |
| Provider Name | Sunny Raithatha |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1679240329 PECOS PAC ID: 0042698425 Enrollment ID: I20220526001792 |
| Mailing Address | Practice Location Address |
|---|---|
| Super Vision Llc 461 Central Ave, Jersey City, NJ 07307-2740 Ph: (201) 420-0101 | Super Vision Llc 461 Central Ave, Jersey City, NJ 07307-2740 Ph: (201) 420-0101 |
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