Healthcare Provider Details

I. General information

NPI: 1326527292
Provider Name (Legal Business Name): BEYOND 20 20 FAMILY EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 CRANBURY RD STE I
EAST BRUNSWICK NJ
08816-5405
US

IV. Provider business mailing address

20 SPRUCE MEADOWS DR
MONROE TOWNSHIP NJ
08831-3103
US

V. Phone/Fax

Practice location:
  • Phone: 732-515-3993
  • Fax:
Mailing address:
  • Phone: 732-515-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00628300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00628300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00628300
License Number StateNJ

VIII. Authorized Official

Name: KIRTI PATEL
Title or Position: PRESIDENT
Credential: OD
Phone: 732-770-9311