MEDICARE: VANTAGE EYECARE, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639733918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE EYECARE, LLC

Provider Business Mailing Address
First Line	:	509 S LENOLA RD STE 11A
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-1561
Country	:	US
Telephone Number	:	856-234-0258
Fax Number	:	856-727-9518

Provider Business Practice Location Address
First Line	:	25 HOMESTEAD DR STE A
Second Line	:
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1005
Country	:	US
Telephone Number	:	609-298-0888
Fax Number	:	609-291-1972

Authorized Official
Title or Position	:	PRINCIPAL PHYSICIAN
Name	:	RICHARD B PRINCE
Credential	:
Telephone Number	:	215-396-4211

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/23/2019

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