Provider Demographics
NPI:1649399585
Name:LARRY M FUERMAN OD & SCOTT A FUERMAN OD PTR
Entity Type:Organization
Organization Name:LARRY M FUERMAN OD & SCOTT A FUERMAN OD PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-641-2330
Mailing Address - Street 1:55 E BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2759
Mailing Address - Country:US
Mailing Address - Phone:609-641-2330
Mailing Address - Fax:609-641-5555
Practice Address - Street 1:55 E BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2759
Practice Address - Country:US
Practice Address - Phone:609-641-2330
Practice Address - Fax:609-641-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA039400152W00000X
NJOA0434800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3263304Medicaid
NJ521637Medicare ID - Type Unspecified