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General NPI Number Information
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NPI Number | 1619987062
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Entity Type | Organization
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Legal Business Name | EVESHAM EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 151 W GREENTREE RD SUITE B
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City | MARLTON
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State | NJ
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Zip | 08053-9416
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Country | US
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Telephone | 856-985-0066
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Fax | 856-985-8104
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Provider Business Mailing Address
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Address Line | 65 ROUTE 70 E STE B
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City | MARLTON
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State | NJ
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Zip | 08053-1747
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Country | US
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Telephone | 856-985-0066
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Fax | 856-985-8104
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALBERT J STAAB
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Credential | OD
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Telephone | 856-985-0066
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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 | 27OA00598300
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License Number State | NJ
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