Provider Demographics
NPI:1497817134
Name:FERREIRA, SERGIO R (LDO)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:R
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 CENTRAL AVE
Mailing Address - Street 2:EYE CONTACT VISION CENTER
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2828
Mailing Address - Country:US
Mailing Address - Phone:201-659-2774
Mailing Address - Fax:201-653-7319
Practice Address - Street 1:368 CENTRAL AVE
Practice Address - Street 2:EYE CONTACT VISION CENTER
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2828
Practice Address - Country:US
Practice Address - Phone:201-659-2774
Practice Address - Fax:201-653-7319
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00327300156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030155Medicaid
NJ0030155Medicaid