Provider Demographics
NPI:1821132499
Name:GLENS EYE CARE CENTER INC
Entity Type:Organization
Organization Name:GLENS EYE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:732-617-7001
Mailing Address - Street 1:356 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8262
Mailing Address - Country:US
Mailing Address - Phone:732-617-7001
Mailing Address - Fax:732-617-7003
Practice Address - Street 1:356 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8262
Practice Address - Country:US
Practice Address - Phone:732-617-7001
Practice Address - Fax:732-617-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1156156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4263980001Medicare ID - Type UnspecifiedPROVIDER NUMBER