Provider Demographics
NPI:1003939398
Name:MIDDLETOWN EYE CARE LLC
Entity Type:Organization
Organization Name:MIDDLETOWN EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-747-4443
Mailing Address - Street 1:565 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5047
Mailing Address - Country:US
Mailing Address - Phone:732-747-4443
Mailing Address - Fax:732-747-4439
Practice Address - Street 1:565 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5047
Practice Address - Country:US
Practice Address - Phone:732-747-4443
Practice Address - Fax:732-747-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086484Medicare ID - Type Unspecified