=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013163732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYES BY DR. BONNIE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2008
-----------------------------------------------------
Last Update Date | 05/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 GRAND AVE
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-821-0318
-----------------------------------------------------
Fax | 732-297-5278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 GRAND AVE
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-821-0318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. BONNIE C. SILVERSTEIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 908-930-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00552600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------