Provider Demographics
NPI:1346493210
Name:VISIONARY EYECARE OF NEW JERSEY
Entity Type:Organization
Organization Name:VISIONARY EYECARE OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-310-6947
Mailing Address - Street 1:22122 BRADFORD GREEN SQ
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9219
Mailing Address - Country:US
Mailing Address - Phone:201-310-6947
Mailing Address - Fax:
Practice Address - Street 1:22122 BRADFORD GREEN SQ
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9219
Practice Address - Country:US
Practice Address - Phone:201-310-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00511200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1C753922Medicare UPIN