1194756312 NPI number — AKT EYE CARE, LLC

Table of content: (NPI 1194756312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194756312 NPI number — AKT EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKT EYE CARE, 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:
6
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:
1194756312
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:
215 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-944-9889
Provider Business Mailing Address Fax Number:
201-944-9989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-944-9889
Provider Business Practice Location Address Fax Number:
201-944-9989
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOO
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
GEE YOUNG
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
201-944-9889

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00581500 , 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: 204644 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3545665 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2944687 . This is a "AETNA TRADITIONAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 311462 . This is a "NVA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0053520 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6397147 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3460860 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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