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General NPI Number Information
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NPI Number | 1881832012
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE EYE CARE PROFESSIONAL SERVICE CORPORATION
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 21 CARASALJO DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2308
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Country | US
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Telephone | 732-370-0555
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Fax | 732-370-0556
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Provider Business Mailing Address
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Address Line | 21 CARASALJO DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2308
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Country | US
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Telephone | 732-370-0555
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Fax | 732-370-0556
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAUREN MICHELLE BACHARACH
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Credential | OD
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Telephone | 732-370-0555
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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 | 601000
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License Number State | NJ
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