MEDICARE: WASHINGTON FAMILY 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1659569465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON FAMILY EYECARE LLC

Provider Business Mailing Address
First Line	:	123 W WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-2121
Country	:	US
Telephone Number	:	908-689-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-2121
Country	:	US
Telephone Number	:	908-689-1214
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAIME BLYSKAL MARCOLINI
Credential	:	OD
Telephone Number	:	908-689-1214

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/30/2009

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