Provider Demographics
NPI:1588819122
Name:MAPLE EYECARE, LLC
Entity Type:Organization
Organization Name:MAPLE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-444-3173
Mailing Address - Street 1:257 E RIDGEWOOD AVE
Mailing Address - Street 2:#301
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3886
Mailing Address - Country:US
Mailing Address - Phone:201-444-3173
Mailing Address - Fax:201-251-4868
Practice Address - Street 1:257 E RIDGEWOOD AVE
Practice Address - Street 2:#301
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3886
Practice Address - Country:US
Practice Address - Phone:201-444-3173
Practice Address - Fax:201-251-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty