Provider Demographics
NPI:1407026594
Name:DR FRANK DEGEORGE
Entity Type:Organization
Organization Name:DR FRANK DEGEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-473-1073
Mailing Address - Street 1:103 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3226
Mailing Address - Country:US
Mailing Address - Phone:973-473-1073
Mailing Address - Fax:973-473-1658
Practice Address - Street 1:103 UNION ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3226
Practice Address - Country:US
Practice Address - Phone:973-473-1073
Practice Address - Fax:973-473-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521527Medicare PIN
NJU26906Medicare UPIN
NJ0579820001Medicare NSC