Healthcare Provider Details

I. General information

NPI: 1376593863
Provider Name (Legal Business Name): OMNI EYE SPECIALISTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ROUTE 1 SOUTH BLDG A
ISELIN NJ
08830
US

IV. Provider business mailing address

485 ROUTE 1 SOUTH BLDG A
ISELIN NJ
08830
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-0400
  • Fax: 732-750-1507
Mailing address:
  • Phone: 732-750-0400
  • Fax: 732-750-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J. QUINN
Title or Position: PRESIDENT
Credential: OD
Phone: 732-750-0400