Provider Demographics
NPI:1376730309
Name:GARDEN STATE EYE AND VISION LLC
Entity Type:Organization
Organization Name:GARDEN STATE EYE AND VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ILAXI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-263-3200
Mailing Address - Street 1:140 LITTLETON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1867
Mailing Address - Country:US
Mailing Address - Phone:973-263-3200
Mailing Address - Fax:973-263-3202
Practice Address - Street 1:140 LITTLETON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1867
Practice Address - Country:US
Practice Address - Phone:973-263-3200
Practice Address - Fax:973-263-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00578400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9014403Medicaid
NJ6073830001Medicare NSC
NJ090326Medicare PIN
NJU87501Medicare UPIN