Provider Demographics
NPI:1376780403
Name:EYE INSTITUTE OPTICIANS
Entity Type:Organization
Organization Name:EYE INSTITUTE OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-696-0300
Mailing Address - Street 1:5677 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9821
Mailing Address - Country:US
Mailing Address - Phone:973-208-0400
Mailing Address - Fax:973-208-0663
Practice Address - Street 1:5677 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9821
Practice Address - Country:US
Practice Address - Phone:973-208-0400
Practice Address - Fax:973-208-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00202400156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty