Provider Demographics
NPI:1184843161
Name:PROVISION CONSULTANTS PC
Entity Type:Organization
Organization Name:PROVISION CONSULTANTS PC
Other - Org Name:WEST PARK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJEEV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-493-8700
Mailing Address - Street 1:893 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7205
Mailing Address - Country:US
Mailing Address - Phone:732-493-8700
Mailing Address - Fax:732-493-8707
Practice Address - Street 1:893 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7205
Practice Address - Country:US
Practice Address - Phone:732-493-8700
Practice Address - Fax:732-493-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00582300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ111748Medicare PIN