Healthcare Provider Details

I. General information

NPI: 1164825303
Provider Name (Legal Business Name): JYC EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ENGLE ST #12
ENGLEWOOD NJ
07631-2440
US

IV. Provider business mailing address

200 ENGLE ST #12
ENGLEWOOD NJ
07631-2440
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-2442
  • Fax: 201-569-2552
Mailing address:
  • Phone: 201-569-2442
  • Fax: 201-569-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00614200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00614200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27OA00614200
License Number StateNJ

VIII. Authorized Official

Name: JESSICA J CHOI-LEE
Title or Position: PRESIDENT
Credential: O.D
Phone: 201-916-9224