Provider Demographics
NPI:1396389599
Name:IC LASER EYE CARE, P.C.
Entity Type:Organization
Organization Name:IC LASER EYE CARE, P.C.
Other - Org Name:IC LASER EYE CARE, P.C. NJ OPTOMETRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICEC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEVILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-639-4500
Mailing Address - Street 1:3046 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2815
Mailing Address - Country:US
Mailing Address - Phone:215-639-4500
Mailing Address - Fax:215-604-0355
Practice Address - Street 1:1725 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2711
Practice Address - Country:US
Practice Address - Phone:609-670-0639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty