Provider Demographics
NPI:1326271545
Name:B&B EYE GROUP LLC
Entity Type:Organization
Organization Name:B&B EYE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:KIRCZOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-927-1242
Mailing Address - Street 1:461 STATE ROUTE 10
Mailing Address - Street 2:LEDGEWOOD MALL
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9510
Mailing Address - Country:US
Mailing Address - Phone:973-927-1242
Mailing Address - Fax:973-927-8055
Practice Address - Street 1:461 STATE ROUTE 10
Practice Address - Street 2:LEDGEWOOD MALL
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9510
Practice Address - Country:US
Practice Address - Phone:973-927-1242
Practice Address - Fax:973-927-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00376500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ203435Medicare PIN