Provider Demographics
NPI:1710093836
Name:LIVA EYE CENTER LLC
Entity Type:Organization
Organization Name:LIVA EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-7770
Mailing Address - Street 1:1 WEST RIDGEWOOD AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-444-7770
Mailing Address - Fax:201-445-2570
Practice Address - Street 1:1 WEST RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-444-7770
Practice Address - Fax:201-445-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6395090001Medicare NSC
NJSBQ452359Medicare ID - Type UnspecifiedPROV #
C55312Medicare UPIN
NJ075505Medicare ID - Type UnspecifiedGROUP #