Healthcare Provider Details

I. General information

NPI: 1245682806
Provider Name (Legal Business Name): PRINCETON EYE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PERRINEVILLE RD
MONROE TOWNSHIP NJ
08831-4923
US

IV. Provider business mailing address

419 N HARRISON ST SUITE 104
PRINCETON NJ
08540-3521
US

V. Phone/Fax

Practice location:
  • Phone: 609-655-7776
  • Fax: 609-655-3685
Mailing address:
  • Phone: 609-921-9437
  • Fax: 609-921-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD-1782
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL Y WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-921-9437