Provider Demographics
NPI:1649744863
Name:OPTICAL EYELAND
Entity Type:Organization
Organization Name:OPTICAL EYELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-813-4644
Mailing Address - Street 1:945 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5659
Mailing Address - Country:US
Mailing Address - Phone:732-813-4644
Mailing Address - Fax:732-813-4645
Practice Address - Street 1:945 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5659
Practice Address - Country:US
Practice Address - Phone:732-813-4644
Practice Address - Fax:732-813-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty