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General NPI Number Information
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NPI Number | 1811276975
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Entity Type | Organization
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Legal Business Name | EAST BRUNSWICK EYE CENTER LLC
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 620 CRANBURY RD SUITE 102
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4098
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Country | US
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Telephone | 732-668-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 620 CRANBURY RD SUITE 102
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4098
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Country | US
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Telephone | 732-668-8225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE AVERGON
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Credential | OD
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Telephone | 732-688-8225
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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 |
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License Number State |
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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 |
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License Number State |
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