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General NPI Number Information
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NPI Number | 1659473973
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Entity Type | Organization
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Legal Business Name | BEDMINSTER EYE AND LASER CENTER, P.A.
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 400 MAIN ST.
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City | BEDMINSTER
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State | NJ
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Zip | 07921
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Country | US
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Telephone | 908-781-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | BEDMINSTER
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State | NJ
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Zip | 07921-0103
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Country | US
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Telephone | 908-781-2020
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Fax |
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Authorized Official
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Title or Position | PRACTICE CONSULTANT
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Name | MS. LORI MCCANN
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Credential |
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Telephone | 908-781-2020
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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 | OA05514
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA04973100
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License Number State | NJ
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