=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326527292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEYOND 20 20 FAMILY EYE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2018
-----------------------------------------------------
Last Update Date | 02/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 579 CRANBURY RD STE I
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-515-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 SPRUCE MEADOWS DR
-----------------------------------------------------
City | MONROE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-515-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIRTI PATEL
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 732-770-9311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 27OA00628300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number | 27OA00628300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00628300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------