Provider Demographics
NPI:1346268661
Name:ACADEMIC EYE CENTER PA
Entity Type:Organization
Organization Name:ACADEMIC EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-257-4900
Mailing Address - Street 1:192 SUMMERHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-257-4900
Mailing Address - Fax:732-432-9458
Practice Address - Street 1:192 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4908
Practice Address - Country:US
Practice Address - Phone:732-257-4900
Practice Address - Fax:732-432-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082633OtherMEDICARE PTAN
NJ046694S3VMedicare UPIN
NJ082633OtherMEDICARE PTAN