Healthcare Provider Details

I. General information

NPI: 1760076640
Provider Name (Legal Business Name): SHORE EYE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 CEDAR BRIDGE AVE
BRICK NJ
08723-4150
US

IV. Provider business mailing address

909 CEDAR BRIDGE AVE
BRICK NJ
08723-4150
US

V. Phone/Fax

Practice location:
  • Phone: 732-477-6981
  • Fax:
Mailing address:
  • Phone: 732-477-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY L MARTIN
Title or Position: OWNER
Credential:
Phone: 855-295-4144