Provider Demographics
NPI:1881832012
Name:ADVANCED MOBILE EYE CARE PROFESSIONAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:ADVANCED MOBILE EYE CARE PROFESSIONAL SERVICE CORPORATION
Other - Org Name:ADVANCED MOBILE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BACHARACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-370-0555
Mailing Address - Street 1:21 CARASALJO DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2308
Mailing Address - Country:US
Mailing Address - Phone:732-370-0555
Mailing Address - Fax:732-370-0556
Practice Address - Street 1:21 CARASALJO DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2308
Practice Address - Country:US
Practice Address - Phone:732-370-0555
Practice Address - Fax:732-370-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ601000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty