Healthcare Provider Details

I. General information

NPI: 1659473973
Provider Name (Legal Business Name): BEDMINSTER EYE AND LASER CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST.
BEDMINSTER NJ
07921
US

IV. Provider business mailing address

PO BOX 103
BEDMINSTER NJ
07921-0103
US

V. Phone/Fax

Practice location:
  • Phone: 908-781-2020
  • Fax:
Mailing address:
  • Phone: 908-781-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA05514
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA04973100
License Number StateNJ

VIII. Authorized Official

Name: MS. LORI MCCANN
Title or Position: PRACTICE CONSULTANT
Credential:
Phone: 908-781-2020