Healthcare Provider Details

I. General information

NPI: 1811911423
Provider Name (Legal Business Name): DR. JIM I. CICCARELLO & EYECARE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 U.S. ROUTE 1 MARKETFAIR SUITE 400
PRINCETON NJ
08540
US

IV. Provider business mailing address

3535 U.S. ROUTE 1 MARKETFAIR SUITE 400
PRINCETON NJ
08540
US

V. Phone/Fax

Practice location:
  • Phone: 609-520-1008
  • Fax:
Mailing address:
  • Phone: 609-520-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00545000
License Number StateNJ

VIII. Authorized Official

Name: DR. JIM I. CICCARELLO
Title or Position: PRESIDENT
Credential: O.D.
Phone: 609-520-1008