MEDICARE: DR. ALVIN IRA STERN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	AO 4037	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003819236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN IRA STERN OD

Provider Business Mailing Address
First Line	:	75 W MAIN ST
Second Line	:
City	:	PENNS GROVE
State	:	NJ
Zip	:	08069-1301
Country	:	US
Telephone Number	:	856-299-2112
Fax Number	:	856-299-2147

Provider Business Practice Location Address
First Line	:	75 W MAIN ST
Second Line	:
City	:	PENNS GROVE
State	:	NJ
Zip	:	08069-1301
Country	:	US
Telephone Number	:	856-299-2112
Fax Number	:	856-299-2147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/18/2009

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