Provider Demographics
NPI:1609976836
Name:EYES FOR AMERICA, INC.
Entity Type:Organization
Organization Name:EYES FOR AMERICA, INC.
Other - Org Name:STAR OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:VINCIGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-684-1545
Mailing Address - Street 1:158 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1702
Mailing Address - Country:US
Mailing Address - Phone:973-684-1545
Mailing Address - Fax:973-345-6120
Practice Address - Street 1:158 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1702
Practice Address - Country:US
Practice Address - Phone:973-684-1545
Practice Address - Fax:973-345-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4306152W00000X
NJ5207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5257905Medicaid
NJ0380601Medicaid
NJ3279201Medicaid
NJ147942Medicare PIN
NJ0380601Medicaid
NJ0481700001Medicare NSC
NJ521611ARZMedicare PIN
NJT77825Medicare UPIN
NJ3279201Medicaid