Provider Demographics
NPI:1376593863
Name:OMNI EYE SPECIALISTS P A
Entity Type:Organization
Organization Name:OMNI EYE SPECIALISTS P A
Other - Org Name:OMNI EYE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-750-0400
Mailing Address - Street 1:485 ROUTE 1 SOUTH
Mailing Address - Street 2:BLDG A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:732-750-1507
Practice Address - Street 1:485 ROUTE 1 SOUTH
Practice Address - Street 2:BLDG A
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-750-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOM0WF54610OtherMEDICARE
NJ066960Medicare ID - Type Unspecified
NJ020930Medicare ID - Type Unspecified
NYOM0WF54610OtherMEDICARE