Provider Demographics
NPI:1497865463
Name:PROFESSIONAL EYECARE ASSOCIATES PA
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-986-0202
Mailing Address - Street 1:275 FOREST AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5426
Mailing Address - Country:US
Mailing Address - Phone:201-986-0202
Mailing Address - Fax:201-986-0977
Practice Address - Street 1:275 FOREST AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5426
Practice Address - Country:US
Practice Address - Phone:201-986-0202
Practice Address - Fax:201-986-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00467700152W00000X
NJ27OA00271700152W00000X
NJ27OA00605100152W00000X
NJ27OM00022900152WC0802X, 152WL0500X
NJ27OM00026100152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01131OtherSPECTERA
NJ2849208Medicaid
NJ1K6548OtherHEALTHNET
NJ310832OtherNVA
NJ908499OtherBLOCK VISION
NJP467376OtherOXFORD
NJ60000697OtherGHI
NJ1848OtherDAVIS VISION
NJ410007420OtherRRMCR
NJ28302OtherAUSHC
NJ29534OtherAMERIGROUP
NJNJ4677OtherEYEMED
NJ049739Medicare PIN
NJ908499OtherBLOCK VISION