Provider Demographics
NPI:1164938346
Name:IOE VISION CARE LLC
Entity Type:Organization
Organization Name:IOE VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASUYI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:347-866-6331
Mailing Address - Street 1:9 WAKEMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2114
Mailing Address - Country:US
Mailing Address - Phone:347-866-6331
Mailing Address - Fax:
Practice Address - Street 1:9 WAKEMAN ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2114
Practice Address - Country:US
Practice Address - Phone:347-866-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-25
Last Update Date:2017-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00651300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty