Provider Demographics
NPI:1598856569
Name:ATLANTIC EYECARE ASSOCIATES
Entity Type:Organization
Organization Name:ATLANTIC EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKSBANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-606-7267
Mailing Address - Street 1:50 TOBAGO AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4761
Mailing Address - Country:US
Mailing Address - Phone:732-606-7266
Mailing Address - Fax:732-505-6572
Practice Address - Street 1:1278 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3343
Practice Address - Country:US
Practice Address - Phone:732-606-7266
Practice Address - Fax:732-505-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00551800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty