Basic Information
| Provider Information | |||||||||
| NPI: | 1023397189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYECARE 20/20- WEST ORANGE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 EAGLE ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735601500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 95 NORTHFIELD AVE | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070524731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737318050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 11/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | MULI | ||||||||
| AuthorizedOfficialFirstName: | KERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9735601500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.