Provider Demographics
NPI:1659425551
Name:EMERALD EYES INC
Entity Type:Organization
Organization Name:EMERALD EYES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-974-3937
Mailing Address - Street 1:701 SEA GIRT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2803
Mailing Address - Country:US
Mailing Address - Phone:732-974-3937
Mailing Address - Fax:732-974-6899
Practice Address - Street 1:701 SEA GIRT AVE
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2803
Practice Address - Country:US
Practice Address - Phone:732-974-3937
Practice Address - Fax:732-974-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00475600152W00000X
NJD-1630156FX1800X
NJD-2019156FX1800X
NJ4756332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ334664Medicare PIN
NJ7178409Medicaid