Provider Demographics
NPI:1821681941
Name:FRONT STREET EYECARE
Entity Type:Organization
Organization Name:FRONT STREET EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGEWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-548-5083
Mailing Address - Street 1:6 BRIARCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4021
Mailing Address - Country:US
Mailing Address - Phone:917-548-5083
Mailing Address - Fax:
Practice Address - Street 1:149 FRONT ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3463
Practice Address - Country:US
Practice Address - Phone:917-548-5083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty