Provider Demographics
NPI:1164662870
Name:MENDHAM EYECARE, INC.
Entity Type:Organization
Organization Name:MENDHAM EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-543-7110
Mailing Address - Street 1:88 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1832
Mailing Address - Country:US
Mailing Address - Phone:973-543-7110
Mailing Address - Fax:973-543-6260
Practice Address - Street 1:88 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1832
Practice Address - Country:US
Practice Address - Phone:973-543-7110
Practice Address - Fax:973-543-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00518100332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU36118Medicare UPIN