Provider Demographics
NPI:1316016116
Name:REGIONAL EYE ASSOCIATES
Entity Type:Organization
Organization Name:REGIONAL EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-795-8787
Mailing Address - Street 1:741 MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3527
Mailing Address - Country:US
Mailing Address - Phone:856-795-8787
Mailing Address - Fax:856-795-8688
Practice Address - Street 1:741 MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3527
Practice Address - Country:US
Practice Address - Phone:856-795-8787
Practice Address - Fax:856-795-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0866410001Medicare NSC
065903Medicare ID - Type Unspecified