Provider Demographics
NPI:1174643985
Name:SCOTCH PLAINS EYE CARE CENTER
Entity Type:Organization
Organization Name:SCOTCH PLAINS EYE CARE CENTER
Other - Org Name:NORTH JERSEY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPUANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-322-8040
Mailing Address - Street 1:350 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1121
Mailing Address - Country:US
Mailing Address - Phone:908-322-8040
Mailing Address - Fax:
Practice Address - Street 1:350 PARK AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1121
Practice Address - Country:US
Practice Address - Phone:908-322-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA004234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0476404Medicaid
NJ0476404Medicaid
NJ1977300001Medicare NSC