1184778128 NPI number — THE EYECARE CENTER LLC

Table of content: (NPI 1184778128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184778128 NPI number — THE EYECARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EYECARE CENTER LLC
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:
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:
1184778128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1462 VAN HOUTEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07013-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-493-8817
Provider Business Mailing Address Fax Number:
201-493-8118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMWOOD PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07407-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-493-8817
Provider Business Practice Location Address Fax Number:
201-493-8118
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CINDRARIO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR, MEMBER
Authorized Official Telephone Number:
201-493-8817

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00518300 , 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: 16649 . This is a "AVESIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 144487527 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K2992 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2543080 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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