Active NPI
Vesta Kim, OPTICIAN
- Optician
- East Brunswick, NJ
National Provider Identifier
1205122520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 31TD00367900
- Practice address
- 14-22 Prospect Street
East Brunswick, NJ 08816-5808 - Phone
- (732) 257-3755
- Fax
- (732) 257-5573
- NPI assigned
- Jun 24, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 31TD00367900 | NJ | Primary |
Addresses
Primary practice location
14-22 Prospect Street
East Brunswick, NJ 08816-5808
Mailing address
14-22 Prospect Street
East Brunswick, NJ 08816-5808
Phone (732) 257-3755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31TD00367900 | NJ | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1205122520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14-22 PROSPECT STREET",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088165808",
"telephone_number": "732-257-3755",
"fax_number": "732-257-5573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14-22 PROSPECT STREET",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088165808",
"telephone_number": "732-257-3755",
"fax_number": "732-257-5573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "VESTA",
"credential": "OPTICIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-24",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NJ",
"license": "31TD00367900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.