Provider Demographics
NPI:1417148594
Name:EYE ASSOCIATES OF WAYNE
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF WAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SILODOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-696-0300
Mailing Address - Street 1:968 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3225
Mailing Address - Country:US
Mailing Address - Phone:973-696-0300
Mailing Address - Fax:973-696-0465
Practice Address - Street 1:968 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3225
Practice Address - Country:US
Practice Address - Phone:973-696-0300
Practice Address - Fax:973-696-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06061500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1699858670OtherNPI GROUP
NJ037893OtherMEDICARE GROUP NUMBER
NJ191754Medicare PIN
NJ0672700001Medicare NSC