Provider Demographics
NPI:1417042409
Name:JEFFERY H AUERBACHER JOHN S WHITE
Entity Type:Organization
Organization Name:JEFFERY H AUERBACHER JOHN S WHITE
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-670-1340
Mailing Address - Street 1:556 N RTE 17
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3008
Mailing Address - Country:US
Mailing Address - Phone:201-670-0010
Mailing Address - Fax:201-670-1345
Practice Address - Street 1:556 N RTE 17
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3008
Practice Address - Country:US
Practice Address - Phone:201-670-0010
Practice Address - Fax:201-670-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00402100152W00000X
NJ27OA00406400152W00000X
NJ4064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ577141BESMedicare UPIN
NJ521563Medicare ID - Type UnspecifiedPROVIDER NUMBER
NJ6252020001Medicare NSC