Provider Demographics
NPI:1386037141
Name:EYEDEAL VISION CENTER
Entity Type:Organization
Organization Name:EYEDEAL VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-2525
Mailing Address - Street 1:222 BERGEN BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1300
Mailing Address - Country:US
Mailing Address - Phone:201-945-2525
Mailing Address - Fax:201-945-2528
Practice Address - Street 1:222 BERGEN BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1300
Practice Address - Country:US
Practice Address - Phone:201-945-2525
Practice Address - Fax:201-945-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00604800302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization