Provider Demographics
NPI:1538118773
Name:OPTICAL IMAGE OF LIVINGSTON
Entity Type:Organization
Organization Name:OPTICAL IMAGE OF LIVINGSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-994-1444
Mailing Address - Street 1:112 EISENHOWER PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4995
Mailing Address - Country:US
Mailing Address - Phone:973-994-1444
Mailing Address - Fax:973-994-2333
Practice Address - Street 1:112 EISENHOWER PKWY
Practice Address - Street 2:SUITE 129
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4995
Practice Address - Country:US
Practice Address - Phone:973-994-1444
Practice Address - Fax:973-994-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00578100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070739Medicare ID - Type Unspecified
NJ4869260001Medicare NSC