Provider Demographics
NPI:1578614947
Name:EYEKRAFTERS MEDICAL OPTICS,P.C.
Entity Type:Organization
Organization Name:EYEKRAFTERS MEDICAL OPTICS,P.C.
Other - Org Name:EYEKRAFTERS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-822-1100
Mailing Address - Street 1:911 OAK TREE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5130
Mailing Address - Country:US
Mailing Address - Phone:908-822-1100
Mailing Address - Fax:908-822-1102
Practice Address - Street 1:911 OAK TREE AVE STE C
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5130
Practice Address - Country:US
Practice Address - Phone:908-822-1100
Practice Address - Fax:908-822-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA05164152W00000X
NJ0A05164332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6330100Medicaid
045082Medicare ID - Type Unspecified
U83512Medicare UPIN