JDN Vista LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA006547OO Issued in NJ

Legal business name

JDN VISTA LLC

Practice address

200 Promenade Blvd
Target Optical
Bridgewater, NJ 08807-3456

Phone

(732) 357-1168

NPI assigned

Nov 30, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David SamuelNPI 1073921508

Title

Optometrist/Owner

Phone

(914) 500-3962

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Alex Samuel, O.D.

  • Optometrist
  • Budd Lake, NJ
  • NPI 1073921508
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1891238341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 VILLAGE GRN",
            "address_2": "APT E",
            "city": "BUDD LAKE",
            "state": "NJ",
            "postal_code": "078281328",
            "telephone_number": "914-500-3962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PROMENADE BLVD",
            "address_2": "TARGET OPTICAL",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088073456",
            "telephone_number": "732-357-1168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDN VISTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "914-500-3962"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA006547OO",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Voulda Alicia James, BA
• Jamie on Optometry LLC
• Laura Jaramillo-Palacio
• Clara Javier, BA, MSW INTERN
• Gabrielle Jayne
• Lauren Jefferson
• Jeffrey C Danco PSYD
• Teresa H. Jimenez MD, M.D.
• Jogohealth Inc
• John L. Lipani DMD and David a. Lipani DMD LLC

• Optometrist in Bridgewater, NJ
• Providers in Bridgewater, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.