Provider Demographics
NPI:1609037001
Name:ANDOVER EYE CARE, L.L.C.
Entity Type:Organization
Organization Name:ANDOVER EYE CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COVUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-579-3937
Mailing Address - Street 1:11 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2794
Mailing Address - Country:US
Mailing Address - Phone:973-579-3937
Mailing Address - Fax:973-579-9825
Practice Address - Street 1:11 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2794
Practice Address - Country:US
Practice Address - Phone:973-579-3937
Practice Address - Fax:973-579-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ233787Medicare UPIN