Provider Demographics
NPI:1942322367
Name:EYE CONTACT OF ELIZABETH, INC.
Entity Type:Organization
Organization Name:EYE CONTACT OF ELIZABETH, INC.
Other - Org Name:ELIZABETH FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-351-6277
Mailing Address - Street 1:1167 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2211
Mailing Address - Country:US
Mailing Address - Phone:908-351-6277
Mailing Address - Fax:908-351-6338
Practice Address - Street 1:1167 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2211
Practice Address - Country:US
Practice Address - Phone:908-351-6277
Practice Address - Fax:908-351-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00253100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6053203Medicaid