Provider Demographics
NPI:1710953963
Name:WASSER EDELSTEIN, VICKI (OD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:WASSER EDELSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2432
Mailing Address - Country:US
Mailing Address - Phone:856-779-7595
Mailing Address - Fax:856-779-7596
Practice Address - Street 1:38 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2432
Practice Address - Country:US
Practice Address - Phone:856-779-7595
Practice Address - Fax:856-779-7596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 4979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26010OtherAMERICHOICE
NJ35237OtherDAVIS VISION
NJ0479514000OtherAMERIHEALTH/KEYSTONE
NJNJ84996OtherVISION BENFITS AMERICA
NJ1013700Medicaid
NJ144717OtherCOLE VISION/EYEMED
NJ24019OtherAETNA
NJ2K1497OtherHEALTHNET
NJ648563OtherBC/BS PA
NJ3416397OtherCIGNA
NJ26010OtherSPECTERA
NJ0149290001OtherMDCR DMERC
NJ3416397OtherCIGNA
NJ1013700Medicaid