Provider Demographics
NPI:1396411567
Name:CITY EYES ,LLC
Entity Type:Organization
Organization Name:CITY EYES ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:856-963-7000
Mailing Address - Street 1:300 BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2034
Mailing Address - Country:US
Mailing Address - Phone:856-963-7000
Mailing Address - Fax:856-963-7007
Practice Address - Street 1:300 BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2034
Practice Address - Country:US
Practice Address - Phone:856-963-7000
Practice Address - Fax:856-963-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0194590Medicaid