Provider Demographics
NPI:1285862961
Name:COURT HOUSE EYE CARE INC
Entity Type:Organization
Organization Name:COURT HOUSE EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SEPPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-465-2728
Mailing Address - Street 1:315 S MAIN ST STE 1
Mailing Address - Street 2:ROUTE 9 SOUTH
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2359
Mailing Address - Country:US
Mailing Address - Phone:609-465-2728
Mailing Address - Fax:609-465-2739
Practice Address - Street 1:315 S MAIN ST STE 1
Practice Address - Street 2:ROUTE 9 SOUTH
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2359
Practice Address - Country:US
Practice Address - Phone:609-465-2728
Practice Address - Fax:609-465-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD-1326332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3403807-01Medicaid
NJ3403807-01Medicaid