Provider Demographics
NPI:1689977787
Name:SIMPLY EYECARE LLC.
Entity Type:Organization
Organization Name:SIMPLY EYECARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GAINES-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-831-8381
Mailing Address - Street 1:48 STATE ROUTE 23 NORTH
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-831-8381
Mailing Address - Fax:
Practice Address - Street 1:48 STATE RT 23
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1602
Practice Address - Country:US
Practice Address - Phone:973-831-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00522700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148709Medicare UPIN