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General NPI Number Information
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NPI Number | 1427232289
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Entity Type | Organization
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Legal Business Name | SOMERVILLE FAMILY EYECARE LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 575 ROUTE 28 SUITE 106 BUILDING 1
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City | RARITAN
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State | NJ
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Zip | 08869-1354
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Country | US
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Telephone | 908-725-0144
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Fax | 908-722-6785
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Provider Business Mailing Address
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Address Line | 575 ROUTE 28 SUITE 106 BUILDING 1
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City | RARITAN
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State | NJ
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Zip | 08869-1354
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Country | US
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Telephone | 908-725-0144
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Fax | 908-722-6785
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNA DIGESO
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Credential | O.D.
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Telephone | 908-725-0144
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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 | 27OA00573100
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License Number State | NJ
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