Provider Demographics
NPI:1164418810
Name:FORNASIER, LOUIS JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JOHN
Last Name:FORNASIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6725 BLACK HORSE PIKE
Mailing Address - Street 2:BOSCOV OPTOCAL DEPT
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-3904
Mailing Address - Country:US
Mailing Address - Phone:609-742-3353
Mailing Address - Fax:609-652-6770
Practice Address - Street 1:6725 BLACK HORSE PIKE
Practice Address - Street 2:BOSCOV OPTOCAL DEPT
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-3904
Practice Address - Country:US
Practice Address - Phone:609-742-3353
Practice Address - Fax:609-652-6770
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00341000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP831238OtherOXFORD
NJ1K4922OtherHEALTH NET
NJ1212631003OtherCIGNA
NJ55603OtherAETNA
NJ2344106Medicaid
NJ889661OtherUNITED HEALTHCARE
NJ0090213000OtherAMERIHEALTH
NJU17702Medicare UPIN
NJ1K4922OtherHEALTH NET