Provider Demographics
NPI:1740400340
Name:DOVER EYE CARE CENTER PC
Entity Type:Organization
Organization Name:DOVER EYE CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-366-0008
Mailing Address - Street 1:369 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2560
Mailing Address - Country:US
Mailing Address - Phone:973-366-0008
Mailing Address - Fax:973-366-1333
Practice Address - Street 1:369 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:973-366-0008
Practice Address - Fax:973-366-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00505701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0077577Medicaid
NJ096146Medicare ID - Type UnspecifiedMEDICARE ID#