Provider Demographics
NPI:1356849525
Name:PROVISION EYECARE CENTER
Entity Type:Organization
Organization Name:PROVISION EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTERO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:347-683-1024
Mailing Address - Street 1:2010 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6014
Mailing Address - Country:US
Mailing Address - Phone:347-683-1024
Mailing Address - Fax:
Practice Address - Street 1:2010 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6014
Practice Address - Country:US
Practice Address - Phone:347-683-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty