Provider Demographics
NPI:1609966332
Name:EYEXAM GROUP - TOTOWA, P.A.
Entity Type:Organization
Organization Name:EYEXAM GROUP - TOTOWA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-890-7070
Mailing Address - Street 1:125 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2338
Mailing Address - Country:US
Mailing Address - Phone:973-890-7070
Mailing Address - Fax:973-890-2787
Practice Address - Street 1:125 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2338
Practice Address - Country:US
Practice Address - Phone:973-890-7070
Practice Address - Fax:973-890-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJEY749626Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER