Provider Demographics
NPI:1063656338
Name:COOPER RIVER EYE ASSOCIATES
Entity Type:Organization
Organization Name:COOPER RIVER EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KAISTHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-488-4404
Mailing Address - Street 1:6981 N PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4205
Mailing Address - Country:US
Mailing Address - Phone:856-488-4404
Mailing Address - Fax:856-488-5207
Practice Address - Street 1:6981 N PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4205
Practice Address - Country:US
Practice Address - Phone:856-488-4404
Practice Address - Fax:856-488-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00591800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ256747Medicare PIN