Provider Demographics
NPI:1457684128
Name:NJ EYE DOCTOR CORP
Entity Type:Organization
Organization Name:NJ EYE DOCTOR CORP
Other - Org Name:JACKSON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEJZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-987-4357
Mailing Address - Street 1:180 N COUNTY LINE RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4797
Mailing Address - Country:US
Mailing Address - Phone:732-987-4357
Mailing Address - Fax:732-987-4359
Practice Address - Street 1:180 N COUNTY LINE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4797
Practice Address - Country:US
Practice Address - Phone:732-861-5800
Practice Address - Fax:732-987-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00615900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ173661ZF21Medicare UPIN