MEDICARE: CHERRY HILL EYECARE, P.A.

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	332H00000X	Eyewear Supplier	OA00276200	NJ

General Provider Information

NPI Number	:	1760412514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERRY HILL EYECARE, P.A.

Provider Business Mailing Address
First Line	:	1188 ROUTE 70 EAST
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-2131
Country	:	US
Telephone Number	:	856-795-6444
Fax Number	:	856-795-2828

Provider Business Practice Location Address
First Line	:	1188 ROUTE 70 EAST
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-2131
Country	:	US
Telephone Number	:	856-795-6444
Fax Number	:	856-795-2828

Authorized Official
Title or Position	:	SECRETARY TREASURER
Name	:	DR. JOEL WILLIAM LAVESON
Credential	:	O.D.
Telephone Number	:	856-795-6444

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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