Provider Demographics
NPI:1376708313
Name:SPARE PAIR IV
Entity Type:Organization
Organization Name:SPARE PAIR IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-335-0004
Mailing Address - Street 1:2145 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1164
Mailing Address - Country:US
Mailing Address - Phone:732-335-0004
Mailing Address - Fax:732-335-0006
Practice Address - Street 1:2145 ROUTE 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1164
Practice Address - Country:US
Practice Address - Phone:732-335-0004
Practice Address - Fax:732-335-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty