Provider Demographics
NPI:1427232289
Name:SOMERVILLE FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:SOMERVILLE FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGESO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-725-0144
Mailing Address - Street 1:575 ROUTE 28 SUITE 106
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1354
Mailing Address - Country:US
Mailing Address - Phone:908-725-0144
Mailing Address - Fax:908-722-6785
Practice Address - Street 1:575 ROUTE 28 SUITE 106
Practice Address - Street 2:BUILDING 1
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1354
Practice Address - Country:US
Practice Address - Phone:908-725-0144
Practice Address - Fax:908-722-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00573100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP5109OtherEYEMED
=========OtherUNITED HEALTHCARE
=========OtherAETNA
=========OtherVISION SERVICE PLAN
=========OtherCIGNA
=========OtherQUALCARE PPO & HMO
=========OtherVISION CARE PLAN
=========OtherHORIZON BLUE CROSS/SHIELD
CP5109OtherEYEMED
=========OtherOXFORD
=========OtherMULTIPLAN
=========OtherVISION CARE PLAN