Provider Demographics
NPI:1568679793
Name:FAMILY EYE CARE ASSOCIATES OF MARLBORO, LLC
Entity Type:Organization
Organization Name:FAMILY EYE CARE ASSOCIATES OF MARLBORO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:REPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-233-5177
Mailing Address - Street 1:100 EAST BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2112
Mailing Address - Country:US
Mailing Address - Phone:908-233-5177
Mailing Address - Fax:908-232-8566
Practice Address - Street 1:100 EAST BROAD ST.
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2112
Practice Address - Country:US
Practice Address - Phone:908-233-5177
Practice Address - Fax:908-232-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00565200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110355Medicare PIN