Provider Demographics
NPI:1134485287
Name:ADVANCED EYECARE AND LASER CENTER PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE AND LASER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-939-9111
Mailing Address - Street 1:619 W CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1926
Mailing Address - Country:US
Mailing Address - Phone:856-939-9111
Mailing Address - Fax:856-939-9650
Practice Address - Street 1:619 W CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1926
Practice Address - Country:US
Practice Address - Phone:856-939-9111
Practice Address - Fax:856-939-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2403404Medicaid
NJC58217Medicare UPIN
NJ2403404Medicaid