Provider Demographics
NPI:1629071295
Name:OPTOMETRIC PHYSICIANS OF HAZLET, PA
Entity Type:Organization
Organization Name:OPTOMETRIC PHYSICIANS OF HAZLET, PA
Other - Org Name:EYESFIRST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GERSHENOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-739-4000
Mailing Address - Street 1:3013 HWY 35
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1526
Mailing Address - Country:US
Mailing Address - Phone:732-739-4000
Mailing Address - Fax:732-739-4002
Practice Address - Street 1:3013 HWY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1526
Practice Address - Country:US
Practice Address - Phone:732-739-4000
Practice Address - Fax:732-739-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3121402Medicaid
NJ016752Medicare ID - Type Unspecified