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General NPI Number Information
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NPI Number | 1386186633
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Entity Type | Organization
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Legal Business Name | EYES ON EVESHAM, L.L.C.
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 751 ROUTE 73 S
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City | EVESHAM
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State | NJ
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Zip | 08053-9637
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Country | US
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Telephone | 856-396-3183
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Fax | 855-595-2570
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Provider Business Mailing Address
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Address Line | 610 CROSS KEYS RD STE 203
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-9580
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | GAITHRI RAMANATHAN
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Credential |
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Telephone | 856-396-3183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00610001
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License Number State | NJ
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