Provider Demographics
NPI:1457496333
Name:OCEAN CITY VISION CENTER
Entity Type:Organization
Organization Name:OCEAN CITY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-391-2121
Mailing Address - Street 1:752 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226
Mailing Address - Country:US
Mailing Address - Phone:609-391-2121
Mailing Address - Fax:
Practice Address - Street 1:752 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3721
Practice Address - Country:US
Practice Address - Phone:609-391-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0184680001Medicare NSC
NJ0184680001Medicare ID - Type Unspecified