Provider Demographics
NPI:1619613312
Name:BOGOTA FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:BOGOTA FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-488-7855
Mailing Address - Street 1:137 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1623
Mailing Address - Country:US
Mailing Address - Phone:201-488-7855
Mailing Address - Fax:201-488-1636
Practice Address - Street 1:137 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1623
Practice Address - Country:US
Practice Address - Phone:201-488-7855
Practice Address - Fax:201-488-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty