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General NPI Number Information
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NPI Number | 1811230857
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Entity Type | Organization
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Legal Business Name | EYE CARE CENTER OF BORDENTOWN, LLC
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 231 CROSSWICKS RD STE 1
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2602
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Country | US
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Telephone | 609-379-6014
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Fax | 609-379-6037
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Provider Business Mailing Address
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Address Line | 231 CROSSWICKS RD STE 1
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2602
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Country | US
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Telephone | 609-379-6014
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Fax | 609-379-6037
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KERRY L WILLIAMS
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Credential | OD
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Telephone | 609-379-6014
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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 | 27OA00575400
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License Number State | NJ
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