Provider Demographics
NPI:1154462034
Name:EYECARE PHYSICIANS & SURGEONS OF NJ
Entity Type:Organization
Organization Name:EYECARE PHYSICIANS & SURGEONS OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-654-6140
Mailing Address - Street 1:73 SOUTH MAIN STREET
Mailing Address - Street 2:EYECARE PHYSICIANS & SURGEONS OF NJ
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-654-6140
Mailing Address - Fax:609-953-2257
Practice Address - Street 1:73 SOUTH MAIN STREET
Practice Address - Street 2:EYECARE PHYSICIANS & SURGEONS OF NJ
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:609-654-6140
Practice Address - Fax:609-953-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128609OtherAETNA US HEALTHCARE
NJ8235007Medicaid
NJ8235007Medicaid
NJ037100Medicare ID - Type Unspecified