Provider Demographics
NPI:1518041268
Name:CLASSIC EYEWEAR INC.
Entity Type:Organization
Organization Name:CLASSIC EYEWEAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:URETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-927-4424
Mailing Address - Street 1:2021 NEW RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1045
Mailing Address - Country:US
Mailing Address - Phone:609-927-4424
Mailing Address - Fax:609-927-3897
Practice Address - Street 1:2021 NEW RD
Practice Address - Street 2:SUITE 6
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1045
Practice Address - Country:US
Practice Address - Phone:609-927-4424
Practice Address - Fax:609-927-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00175889OtherRAILROAD MEDICARE
P00175889OtherRAILROAD MEDICARE