MEDICARE: IRVINGTON EYE CARE LIMITED LIABILITY COMPANY

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	27OA00601302	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	:	1578864682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRVINGTON EYE CARE LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	1091B SPRINGFIELD AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2408
Country	:	US
Telephone Number	:	973-416-6664
Fax Number	:	973-416-6649

Provider Business Practice Location Address
First Line	:	1091B SPRINGFIELD AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-2408
Country	:	US
Telephone Number	:	973-416-6664
Fax Number	:	973-416-6649

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MILI CHITALIA
Credential	:	O.D.
Telephone Number	:	973-416-6664

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/26/2013

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