John Jacob Daub IV, O.D.
Individual provider Active NPI Optometrist · Rutherford, NJ
NPI 1396254751 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1396254751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 27OA00674800 (NJ)
- Practice address
- 31 Park Ave
Rutherford, NJ 07070-1711 - Phone
- (201) 939-2463
- NPI assigned
- Sep 28, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190926002960 | NJ | Practitioner - Optometry | 4284964628 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27OA00674800 | NJ | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Robert Schorn Purnell LLC | Optometrist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 27OA00674800 | NJ | Yes |
Addresses
Primary practice location
31 Park Ave
Rutherford, NJ 07070-1711
Mailing address
31 Park Ave
Rutherford, NJ 07070-1711
Phone (201) 939-2463
Other providers in Rutherford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.