Provider Demographics
NPI:1053493627
Name:EYEXAM GROUP - WATCHUNG PA
Entity Type:Organization
Organization Name:EYEXAM GROUP - WATCHUNG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-322-5020
Mailing Address - Street 1:1688 ROUTE 22 E
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6508
Mailing Address - Country:US
Mailing Address - Phone:908-322-5020
Mailing Address - Fax:908-322-1938
Practice Address - Street 1:1688 ROUTE 22 E
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6508
Practice Address - Country:US
Practice Address - Phone:908-322-5020
Practice Address - Fax:908-322-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00411100152W00000X
NJ27OA00411000152W00000X
NJ27TO00020200152WC0802X
NJ27TO00020300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ713456Medicare PIN