Provider Demographics
NPI:1114220720
Name:POLKAN VISION PC
Entity Type:Organization
Organization Name:POLKAN VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-985-3854
Mailing Address - Street 1:231 GRANT AVE
Mailing Address - Street 2:UNIT 18
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1103
Mailing Address - Country:US
Mailing Address - Phone:973-985-3854
Mailing Address - Fax:
Practice Address - Street 1:118 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2917
Practice Address - Country:US
Practice Address - Phone:973-239-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00617200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ232470Medicare PIN