Provider Demographics
NPI:1740606649
Name:GARDEN STATE EYE GROUP, INC.
Entity Type:Organization
Organization Name:GARDEN STATE EYE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-376-5555
Mailing Address - Street 1:100 ROUTE 46 W
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 US HIGHWAY 22 E STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3128
Practice Address - Country:US
Practice Address - Phone:973-376-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00632500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty