Provider Demographics
NPI:1083913362
Name:YOUR EYES CINNAMINSON
Entity Type:Organization
Organization Name:YOUR EYES CINNAMINSON
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-829-3103
Mailing Address - Street 1:1251 ROUTE 130 S
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3005
Mailing Address - Country:US
Mailing Address - Phone:856-829-3103
Mailing Address - Fax:856-829-3102
Practice Address - Street 1:1251 RT 130 SOUTH
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-829-3103
Practice Address - Fax:856-829-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty