Healthcare Provider Details
I. General information
NPI: 1164528980
Provider Name (Legal Business Name): PRINCETON EYE GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/16/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
419 NORTH HARRISON STREET SUITE 104
PRINCETON NJ
08540
US
IV. Provider business mailing address
419 NORTH HARRISON STREET SUITE 104
PRINCETON NJ
08540
US
V. Phone/Fax
- Phone: 609-921-9437
- Fax: 609-688-9941
- Phone: 609-921-9437
- Fax: 609-688-9941
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
STEPHEN
M
FELTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-921-9437