1093797912 NPI number — DR. IVY HOPP SPEARS O.D.

Table of content: DERAIL HOLCOMB (NPI 1427684976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093797912 NPI number — DR. IVY HOPP SPEARS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEARS
Provider First Name:
IVY
Provider Middle Name:
HOPP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1093797912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 BEY LEA RD
Provider Second Line Business Mailing Address:
BEY LEA COMMONS SUITE C 104
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-341-1070
Provider Business Mailing Address Fax Number:
732-341-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 BEY LEA RD
Provider Second Line Business Practice Location Address:
BEY LEA COMMONS SUITE C 104
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-341-1070
Provider Business Practice Location Address Fax Number:
732-341-1652
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00435400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 27OA00435400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 27OA00435400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: 27OA00435400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 27OA00435400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0075755000 . This is a "AMERIHEALTH IND PROV ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 201330164 . This is a "QUALCARE GROUP ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3275906 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50596 . This is a "DAVIS VISION ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60016235 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 310954 . This is a "NATIONAL VISION ADMIN ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0055395 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2K7427 . This is a "HEALTHNET IND ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000500200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3628546 . This is a "AETNA (HMO)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P466316 . This is a "OXFORD IND ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30903 . This is a "GROUP VISION ASSOC ID NUM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: G3410217 . This is a "OXFORD GROUP ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 201330164 . This is a "HORIZON BC/BS ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2341813000 . This is a "AMERIHEALTH GROUP ID NUMB" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3242884 . This is a "CIGNA IND ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4502254 . This is a "AETNA (NON-HMO)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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