Provider Demographics
NPI:1093737017
Name:SHORE EYE ASSOCIATES PA
Entity Type:Organization
Organization Name:SHORE EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WNOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-341-4733
Mailing Address - Street 1:530 LAKEHURST ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8021
Mailing Address - Country:US
Mailing Address - Phone:732-341-4733
Mailing Address - Fax:732-341-2794
Practice Address - Street 1:530 LAKEHURST ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8021
Practice Address - Country:US
Practice Address - Phone:732-341-4733
Practice Address - Fax:732-341-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7988800Medicaid
NJ7988800Medicaid
NJ0685090001Medicare NSC