MEDICARE: DR. LOUIS JOHN FORNASIER O.D.

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	27OA00341000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P831238	OTHER	NJ	OXFORD
2	1K4922	OTHER	NJ	HEALTH NET
3	1212631003	OTHER	NJ	CIGNA
4	55603	OTHER	NJ	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	889661	OTHER	NJ	UNITED HEALTHCARE
7	0090213000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1164418810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS JOHN FORNASIER O.D.

Provider Business Mailing Address
First Line	:	6725 BLACK HORSE PIKE
Second Line	:	BOSCOV OPTOCAL DEPT
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-3904
Country	:	US
Telephone Number	:	609-742-3353
Fax Number	:	609-652-6770

Provider Business Practice Location Address
First Line	:	6725 BLACK HORSE PIKE
Second Line	:	BOSCOV OPTOCAL DEPT
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-3904
Country	:	US
Telephone Number	:	609-742-3353
Fax Number	:	609-652-6770

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	11/07/2016

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