Provider Demographics
NPI:1255650743
Name:J& J PREMIUM EYE CARE INC
Entity Type:Organization
Organization Name:J& J PREMIUM EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:516-442-1570
Mailing Address - Street 1:1304 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1418
Mailing Address - Country:US
Mailing Address - Phone:516-442-1570
Mailing Address - Fax:516-442-1573
Practice Address - Street 1:1304 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1418
Practice Address - Country:US
Practice Address - Phone:516-442-1570
Practice Address - Fax:516-442-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-23
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03258775Medicaid
NY55 009105OtherOPTICIAN
NY03258775Medicaid