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General NPI Number Information
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NPI Number | 1346783966
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Entity Type | Organization
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Legal Business Name | EYECARE ON EASTON,LLC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 1075 EASTON AVE SUITE 12B
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City | SOMERSET
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State | NJ
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Zip | 08873-1648
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Country | US
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Telephone | 732-214-1600
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Fax | 732-214-0124
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Provider Business Mailing Address
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Address Line | 1075 EASTON AVE SUITE 12B
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City | SOMERSET
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State | NJ
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Zip | 08873-1648
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Country | US
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Telephone | 732-214-1600
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Fax | 732-214-0124
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAN VAYNER
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Credential |
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Telephone | 732-214-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 27OM00099601
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License Number State | NJ
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