Provider Demographics
NPI:1619987062
Name:EVESHAM EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EVESHAM EYE ASSOCIATES, INC.
Other - Org Name:MARLTON EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAAB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-985-0066
Mailing Address - Street 1:65 ROUTE 70 E STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1747
Mailing Address - Country:US
Mailing Address - Phone:856-985-0066
Mailing Address - Fax:856-985-8104
Practice Address - Street 1:151 W GREENTREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9416
Practice Address - Country:US
Practice Address - Phone:856-985-0066
Practice Address - Fax:856-985-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00598300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty