Basic Information
| Provider Information | |||||||||
| NPI: | 1487927984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE OF THE TIGER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3320 QUAKERBRIDGE MALL | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097990809 | ||||||||
| FaxNumber: | 6097992566 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 QUAKERBRIDGE MALL | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097990809 | ||||||||
| FaxNumber: | 6097992566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2012 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHETH | ||||||||
| AuthorizedOfficialFirstName: | POOJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 6097990809 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.