Healthcare Provider Details

I. General information

NPI: 1962525584
Provider Name (Legal Business Name): EYE INSTITUTE OF SOUTH JERSEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 E CHESTNUT AVE SUITE B 6
VINELAND NJ
08361-7847
US

IV. Provider business mailing address

3071 E CHESTNUT AVE SUITE B 6
VINELAND NJ
08361-7847
US

V. Phone/Fax

Practice location:
  • Phone: 856-205-1100
  • Fax: 856-205-1100
Mailing address:
  • Phone: 856-205-1100
  • Fax: 856-205-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00581400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA56275
License Number StateNJ

VIII. Authorized Official

Name: MRS. FAWN C PERNELLI
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 856-205-1100