Provider Demographics
NPI:1679673644
Name:PRINCETON EYE GROUP,PA
Entity Type:Organization
Organization Name:PRINCETON EYE GROUP,PA
Other - Org Name:FELTON, WONG, WONG AND REYNOLDS, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-9437
Mailing Address - Street 1:419 NORTH HARRISON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-921-9437
Mailing Address - Fax:609-688-9941
Practice Address - Street 1:900 EASTON AVENUE
Practice Address - Street 2:SUITE 50
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-565-9550
Practice Address - Fax:732-565-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3035701Medicaid
NJ3035701Medicaid
NJ101489Medicare PIN