Provider Demographics
NPI:1164692620
Name:ASSOCIATES IN OPHTHALMOLOGY LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN OPHTHALMOLOGY LLC
Other - Org Name:OPTICAL BOUTIQUE
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-740-0111
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-740-0111
Mailing Address - Fax:
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-740-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES IN OPHTHALMOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00370600332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0790620001Medicare NSC