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General NPI Number Information
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NPI Number | 1659425551
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Entity Type | Organization
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Legal Business Name | EMERALD EYES INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 701 SEA GIRT AVE
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City | SEA GIRT
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State | NJ
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Zip | 08750-2803
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Country | US
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Telephone | 732-974-3937
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Fax | 732-974-6899
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Provider Business Mailing Address
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Address Line | 701 SEA GIRT AVE
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City | SEA GIRT
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State | NJ
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Zip | 08750-2803
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Country | US
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Telephone | 732-974-3937
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Fax | 732-974-6899
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. SEAN P PHIBBS
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Credential | O.D.
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Telephone | 732-974-3937
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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 | 27OA00475600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D-1630
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D-2019
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4756
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License Number State | NJ
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