Provider Demographics
NPI:1568618163
Name:DENVILLE FAMILY EYECARE
Entity Type:Organization
Organization Name:DENVILLE FAMILY EYECARE
Other - Org Name:ROCKAWAY EYE ASSCOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIANS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TREZZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-983-0400
Mailing Address - Street 1:5 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2175
Mailing Address - Country:US
Mailing Address - Phone:973-983-0400
Mailing Address - Fax:973-215-2122
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2175
Practice Address - Country:US
Practice Address - Phone:973-983-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ5208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148409Medicare PIN
NJDT0952Medicare PIN