Provider Demographics
NPI:1326262338
Name:MAIN EYE GLASS CENTER, INC.
Entity Type:Organization
Organization Name:MAIN EYE GLASS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DELLO RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-384-7333
Mailing Address - Street 1:1 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2125
Mailing Address - Country:US
Mailing Address - Phone:201-384-7333
Mailing Address - Fax:201-384-9915
Practice Address - Street 1:1 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2125
Practice Address - Country:US
Practice Address - Phone:201-384-7333
Practice Address - Fax:201-384-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0700900001Medicare NSC
NJC53940Medicare UPIN