Healthcare Provider Details

I. General information

NPI: 1972191666
Provider Name (Legal Business Name): EYE HEALTH GROUP OF TR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 22 E
SPRINGFIELD NJ
07081-3554
US

IV. Provider business mailing address

275 ROUTE 22 E
SPRINGFIELD NJ
07081-3554
US

V. Phone/Fax

Practice location:
  • Phone: 321-537-9979
  • Fax:
Mailing address:
  • Phone: 321-537-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDY NISSINOFF
Title or Position: CEO
Credential: MD
Phone: 321-537-9979