Basic Information
| Provider Information | |||||||||
| NPI: | 1003017294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | SAJI | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 SPRING VIEW DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189664308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152754073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 QUAKER BRIDGE MALL | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086481900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097990809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 27OA00563600 | NJ | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.