MEDICARE: 9W EYECARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA000444200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497998884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	9W EYECARE, LLC

Provider Business Mailing Address
First Line	:	44 SYLVAN AVE STE 1B
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 SYLVAN AVE STE 1B
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2417
Country	:	US
Telephone Number	:	201-592-1998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HENRY CHAUNG
Credential	:
Telephone Number	:	201-592-1998

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	08/20/2009

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