Healthcare Provider Details

I. General information

NPI: 1780772046
Provider Name (Legal Business Name): OUTLOOK EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTRE DR SUITE 1B
MONROE TOWNSHIP NJ
08831-1564
US

IV. Provider business mailing address

5 CENTRE DR SUITE 1B
MONROE TOWNSHIP NJ
08831-1564
US

V. Phone/Fax

Practice location:
  • Phone: 609-409-2778
  • Fax: 609-409-2718
Mailing address:
  • Phone: 609-409-2778
  • Fax: 609-409-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA03961900
License Number StateNJ

VIII. Authorized Official

Name: DR. WAYNE MICHAEL GRABOWSKI
Title or Position: PRES.
Credential: M.D.
Phone: 609-409-2778