Provider Demographics
NPI:1700220886
Name:FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYSHELIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-259-5059
Mailing Address - Street 1:515 N WOOD AVE
Mailing Address - Street 2:SUITE 102 FAMILY EYECARE LLC
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-259-5059
Mailing Address - Fax:
Practice Address - Street 1:515 N WOOD AVE
Practice Address - Street 2:SUITE 102 FAMILY EYECARE LLC
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-259-5059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00618300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ298294Medicare PIN