Provider Demographics
NPI:1598412330
Name:MOSTAFAVI EYE LLC
Entity Type:Organization
Organization Name:MOSTAFAVI EYE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-255-2019
Mailing Address - Street 1:300 WITHERSPOON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-3401
Mailing Address - Country:US
Mailing Address - Phone:609-480-6698
Mailing Address - Fax:
Practice Address - Street 1:300 WITHERSPOON ST STE 203
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3401
Practice Address - Country:US
Practice Address - Phone:609-480-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty