MEDICARE: MONMOUTH COUNTY PRIMARY EYE CARE 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	:	1851133565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONMOUTH COUNTY PRIMARY EYE CARE LLC

Provider Business Mailing Address
First Line	:	1722 NEW BEDFORD RD
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-3870
Country	:	US
Telephone Number	:	732-531-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 NEW BEDFORD RD
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-3870
Country	:	US
Telephone Number	:	732-504-4194
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/PARTNER
Name	:	TYLER LESKO
Credential	:	OD
Telephone Number	:	732-504-4194

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	02/06/2026

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