Provider Demographics
NPI:1447331392
Name:CARLETTA, JUDITH (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CARLETTA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4329
Mailing Address - Country:US
Mailing Address - Phone:732-892-7717
Mailing Address - Fax:732-892-7836
Practice Address - Street 1:2315 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4329
Practice Address - Country:US
Practice Address - Phone:732-892-7717
Practice Address - Fax:732-892-7836
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDO3007156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8577803Medicaid
NJ313227OtherNVA
NJ02719OtherSPECTERA
NJ110308OtherEYE MED
NJ8577803Medicaid