Provider Demographics
NPI:1083657936
Name:LEBOVIC, JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LEBOVIC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 YORKSHIP SQ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-2800
Mailing Address - Country:US
Mailing Address - Phone:856-964-2020
Mailing Address - Fax:856-964-1060
Practice Address - Street 1:2985 YORKSHIP SQ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-2800
Practice Address - Country:US
Practice Address - Phone:856-964-2020
Practice Address - Fax:856-964-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00376900152W00000X
PAOE005265P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3897605Medicaid
NJU18214Medicare UPIN
NJ029667Medicare PIN