Provider Demographics
NPI:1467079897
Name:JERSEY EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:JERSEY EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRISTD
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAISTHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-322-2529
Mailing Address - Street 1:308 LAUREL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3986
Mailing Address - Country:US
Mailing Address - Phone:917-576-0672
Mailing Address - Fax:
Practice Address - Street 1:462 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2442
Practice Address - Country:US
Practice Address - Phone:856-322-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty