Provider Demographics
NPI:1811230857
Name:EYE CARE CENTER OF BORDENTOWN, LLC
Entity Type:Organization
Organization Name:EYE CARE CENTER OF BORDENTOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-379-6014
Mailing Address - Street 1:231 CROSSWICKS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2602
Mailing Address - Country:US
Mailing Address - Phone:609-379-6014
Mailing Address - Fax:609-379-6037
Practice Address - Street 1:231 CROSSWICKS RD STE 1
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2602
Practice Address - Country:US
Practice Address - Phone:609-379-6014
Practice Address - Fax:609-379-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00575400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049364MBCMedicare UPIN