Provider Demographics
NPI:1659473973
Name:BEDMINSTER EYE AND LASER CENTER, P.A.
Entity Type:Organization
Organization Name:BEDMINSTER EYE AND LASER CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-781-2020
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-0103
Mailing Address - Country:US
Mailing Address - Phone:908-781-2020
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921
Practice Address - Country:US
Practice Address - Phone:908-781-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA05514152W00000X
NJ25MA04973100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTS113OtherOXFORD
NJ1170601Medicaid
NJ27207OtherAETNA
NJOM1314OtherHEALTNET
NJ1170601Medicaid