MEDICARE: ADVANCED EYECARE OF MILLSTONE

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	27OA00599700	NJ

General Provider Information

NPI Number	:	1841475274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EYECARE OF MILLSTONE

Provider Business Mailing Address
First Line	:	498 MONMOUTH RD
Second Line	:	SUITE 2
City	:	CLARKSBURG
State	:	NJ
Zip	:	08510-1219
Country	:	US
Telephone Number	:	609-259-2221
Fax Number	:	609-259-2291

Provider Business Practice Location Address
First Line	:	498 MONMOUTH RD
Second Line	:	SUITE 2
City	:	CLARKSBURG
State	:	NJ
Zip	:	08510-1219
Country	:	US
Telephone Number	:	609-259-2221
Fax Number	:	609-259-2291

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. KINNARI PATEL
Credential	:	OD
Telephone Number	:	609-259-2221

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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