Provider Demographics
NPI:1497798763
Name:GUBMAN EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:GUBMAN EYE ASSOCIATES, PA
Other - Org Name:EYE AND SIGHT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-751-0220
Mailing Address - Street 1:303 SHEPPARD RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4670
Mailing Address - Country:US
Mailing Address - Phone:856-751-0220
Mailing Address - Fax:856-751-0222
Practice Address - Street 1:2 SHEPPARD RD
Practice Address - Street 2:STE 303
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4787
Practice Address - Country:US
Practice Address - Phone:856-751-0220
Practice Address - Fax:856-751-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA0005166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5300100Medicaid
5500480004OtherCIGNA
501029OtherAETNA
0759379000OtherAMERIHEALTH
5500480004OtherCIGNA
501029OtherAETNA
NJGU170369Medicare ID - Type Unspecified
NJ5300100Medicaid