Provider Demographics
NPI:1700038312
Name:EYE SHOPPE OF HOBOKEN PC
Entity Type:Organization
Organization Name:EYE SHOPPE OF HOBOKEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-683-4228
Mailing Address - Street 1:44 NEWARK ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5661
Mailing Address - Country:US
Mailing Address - Phone:201-683-4228
Mailing Address - Fax:
Practice Address - Street 1:44 NEWARK ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5611
Practice Address - Country:US
Practice Address - Phone:201-683-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00606900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ234581YGLJOtherMEDICARE PTAN