Healthcare Provider Details

I. General information

NPI: 1376471144
Provider Name (Legal Business Name): EYEJAVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ROCK RD STE 3101
GLEN ROCK NJ
07452-1747
US

IV. Provider business mailing address

175 ROCK RD STE 3101
GLEN ROCK NJ
07452-1747
US

V. Phone/Fax

Practice location:
  • Phone: 201-285-4223
  • Fax: 201-285-4348
Mailing address:
  • Phone: 201-285-4223
  • Fax: 201-285-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PRANEETHA RAVEENDRANATHAN
Title or Position: OWNER
Credential: OD
Phone: 201-285-4223