Healthcare Provider Details

I. General information

NPI: 1245315969
Provider Name (Legal Business Name): BRIGANTINE EYE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4274 HARBOUR BEACH BLVD
BRIGANTINE NJ
08203-1362
US

IV. Provider business mailing address

4274 HARBOUR BEACH BLVD
BRIGANTINE NJ
08203-1362
US

V. Phone/Fax

Practice location:
  • Phone: 609-266-8000
  • Fax: 609-266-9555
Mailing address:
  • Phone: 609-266-8000
  • Fax: 609-266-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMB54894
License Number StateNJ

VIII. Authorized Official

Name: EUGENE DIMARCO
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 609-266-8000