1255650743 NPI number — J& J PREMIUM EYE CARE INC

Table of content: (NPI 1255650743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255650743 NPI number — J& J PREMIUM EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J& J PREMIUM EYE CARE 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:
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:
1255650743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BALDWIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11510-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-442-1570
Provider Business Mailing Address Fax Number:
516-442-1573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1304 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BALDWIN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11510-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-442-1570
Provider Business Practice Location Address Fax Number:
516-442-1573
Provider Enumeration Date:
05/23/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
516-442-1570

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03258775 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55 009105 . This is a "OPTICIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".