Provider Demographics
NPI:1568612257
Name:CLOSTER EYE CARE, INC.
Entity Type:Organization
Organization Name:CLOSTER EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-564-7700
Mailing Address - Street 1:245 CLOSTER DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2619
Mailing Address - Country:US
Mailing Address - Phone:201-564-7700
Mailing Address - Fax:201-564-7701
Practice Address - Street 1:247 CLOSTER DOCK RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2619
Practice Address - Country:US
Practice Address - Phone:201-564-7700
Practice Address - Fax:201-564-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27AO00603100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
135020OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
135020OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)