Healthcare Provider Details

I. General information

NPI: 1023397189
Provider Name (Legal Business Name): EYECARE 20/20- WEST ORANGE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 NORTHFIELD AVE SUITE #2
WEST ORANGE NJ
07052-4731
US

IV. Provider business mailing address

46 EAGLE ROCK AVE
EAST HANOVER NJ
07936-3104
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-8050
  • Fax:
Mailing address:
  • Phone: 973-560-1500
  • 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: KERI MULI
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-560-1500