1609934207 NPI number — OPTIKA EYECARE, INC.

Table of content: (NPI 1609934207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609934207 NPI number — OPTIKA EYECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIKA EYECARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KINNELON EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609934207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 KINNELON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINNELON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07405-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-838-8190
Provider Business Mailing Address Fax Number:
973-838-3230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 KINNELON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINNELON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07405-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-838-8190
Provider Business Practice Location Address Fax Number:
973-838-3230
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATELLIS
Authorized Official First Name:
NIKI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-838-8190

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00520400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150665995 . This is a "INSURANCE DESIGN ADMINIST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 150665995 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: OK9793 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 150665995 . This is a "WELLCHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2391973 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2391973 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3571408 . This is a "AETNA U.S. HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DC9724 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0672440001 . This is a "DME MAC JURISDICTION A" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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