Healthcare Provider Details

I. General information

NPI: 1083974026
Provider Name (Legal Business Name): CIPPARONE EYE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CLEMENTS BRIDGE RD
DEPTFORD NJ
08096-2016
US

IV. Provider business mailing address

111 PREAKNESS DR
MULLICA HILL NJ
08062-3603
US

V. Phone/Fax

Practice location:
  • Phone: 856-906-6079
  • Fax:
Mailing address:
  • Phone: 856-906-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA005489
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN ANTHONY CIPPARONE
Title or Position: OPTOMETRIST
Credential:
Phone: 856-906-6079