Provider Demographics
NPI:1881640563
Name:ESSEX EYE SURGERY & LASER CENTER
Entity Type:Organization
Organization Name:ESSEX EYE SURGERY & LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-338-5566
Mailing Address - Street 1:1460 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3014
Mailing Address - Country:US
Mailing Address - Phone:973-338-5566
Mailing Address - Fax:973-338-0753
Practice Address - Street 1:1460 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3014
Practice Address - Country:US
Practice Address - Phone:973-338-5566
Practice Address - Fax:973-338-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311031OtherHORIZON BC ID NUMBER
NJ7411405Medicaid
NJ303361Medicare ID - Type UnspecifiedMEDICARE ID NUMBER