Provider Demographics
NPI:1164825303
Name:JYC EYE CARE
Entity Type:Organization
Organization Name:JYC EYE CARE
Other - Org Name:ENGLEWOOD VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOI-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-916-9224
Mailing Address - Street 1:200 ENGLE ST
Mailing Address - Street 2:#12
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2440
Mailing Address - Country:US
Mailing Address - Phone:201-569-2442
Mailing Address - Fax:201-569-2552
Practice Address - Street 1:200 ENGLE ST
Practice Address - Street 2:#12
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2440
Practice Address - Country:US
Practice Address - Phone:201-569-2442
Practice Address - Fax:201-569-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00614200152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0287148Medicaid