Provider Demographics
NPI:1326246919
Name:SOUTH JERSEY EYE CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH JERSEY EYE CENTER, INC.
Other - Org Name:CAMDEN EYE CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-365-2420
Mailing Address - Street 1:400 CHAMBERS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1405
Mailing Address - Country:US
Mailing Address - Phone:856-365-1811
Mailing Address - Fax:856-365-1379
Practice Address - Street 1:400 CHAMBERS AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1405
Practice Address - Country:US
Practice Address - Phone:856-365-1811
Practice Address - Fax:856-365-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2477807Medicaid
NJ2477807Medicaid