Provider Demographics
NPI:1942226303
Name:FSA VISION ASSOCIATES PA
Entity Type:Organization
Organization Name:FSA VISION ASSOCIATES PA
Other - Org Name:ANGELINI VISION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANGELINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-234-5048
Mailing Address - Street 1:401 W ROUTE 38
Mailing Address - Street 2:STE B5
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3235
Mailing Address - Country:US
Mailing Address - Phone:856-234-5048
Mailing Address - Fax:856-234-5899
Practice Address - Street 1:401 W ROUTE 38
Practice Address - Street 2:STE B5
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3235
Practice Address - Country:US
Practice Address - Phone:856-234-5048
Practice Address - Fax:856-234-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ3011205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2862506Medicaid
U26812Medicare UPIN
NJ521178Medicare ID - Type Unspecified
NJ2862506Medicaid