MEDICARE: ENVISION EYECARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WP0200X	Pediatric Optometrist
3	152WS0006X	Sports Vision Optometrist
4	156FC0800X	Contact Lens Technician/Technologist
5	156FX1201X	Optometric Assistant Technician
6	156FX1800X	Optician
7	152WX0102X	Occupational Vision Optometrist
8	152W00000X	Optometrist

General Provider Information

NPI Number	:	1700221710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION EYECARE

Provider Business Mailing Address
First Line	:	561 US HIGHWAY 1
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4400
Country	:	US
Telephone Number	:	732-819-8181
Fax Number	:	732-819-3593

Provider Business Practice Location Address
First Line	:	561 US HIGHWAY 1
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4400
Country	:	US
Telephone Number	:	732-819-8181
Fax Number	:	732-819-3593

Authorized Official
Title or Position	:	OPTEMETRIC PHYSICIAN
Name	:	DR. JOHN J DZURENDA
Credential	:	OD
Telephone Number	:	732-819-8181

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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