Alfonso C. Bullock II, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA00599000 Issued in NJ

Practice address

261A Broad Ave.
Palisades Park, NJ 07650

Phone

(201) 944-3068

NPI assigned

Jul 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891727525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257B 5TH ST",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076502034",
            "telephone_number": "201-947-6590",
            "fax_number": "631-666-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261A BROAD AVE.",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "07650",
            "telephone_number": "201-944-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "ALFONSO",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV-006870-1",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00599000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broad Amdc Inc. (Morning Sun Adult Medical Day Center)
• Broad Pharmacy 1 LLC (Broad Pharmacy)
• Broad Pharmacy, Inc.
• Broadway Optical LLC (Broadway Optical)
• Broadway Optical LLC
• Careone Physical Therapy, P.C.
• Chamomile Counseling LLC
• Kenneth K Chen, D.M.D.
• Winston W Chen, D.D.S. PHD
• Ki-Young Cho

• Optometrist in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.