Provider Demographics
NPI:1316037385
Name:CROSS KEYS FAMILY EYECARE LIMITED LIABILITY CORPORATION
Entity Type:Organization
Organization Name:CROSS KEYS FAMILY EYECARE LIMITED LIABILITY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:RODIO-VIVADELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-481-6510
Mailing Address - Street 1:35 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2113
Practice Address - Country:US
Practice Address - Phone:609-481-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00593800152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty