Provider Demographics
NPI:1467533794
Name:BELLMAWR EYE CARE, LLC
Entity Type:Organization
Organization Name:BELLMAWR EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CERASO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-931-7609
Mailing Address - Street 1:17 E BROWNING RD
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2344
Mailing Address - Country:US
Mailing Address - Phone:856-931-7609
Mailing Address - Fax:856-931-6863
Practice Address - Street 1:17 E BROWNING RD
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2344
Practice Address - Country:US
Practice Address - Phone:856-931-7609
Practice Address - Fax:856-931-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00573200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100111OtherPTAN
NJDE7880Medicare PIN
NJ100111OtherPTAN