Provider Demographics
NPI:1952313280
Name:TOTAL EYE CARE CENTERS PC
Entity Type:Organization
Organization Name:TOTAL EYE CARE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:SHAI
Authorized Official - Middle Name:V
Authorized Official - Last Name:GARDELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-587-2020
Mailing Address - Street 1:1568 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1508
Mailing Address - Country:US
Mailing Address - Phone:215-943-7800
Mailing Address - Fax:215-943-5799
Practice Address - Street 1:1568 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1508
Practice Address - Country:US
Practice Address - Phone:215-943-7800
Practice Address - Fax:215-943-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3492516Medicaid
NJ3492508Medicaid
PA4243OtherTECC - AETNA - GROUP
NJ549069OtherTECC - AETNA - GROUP
PA0657688Medicaid
NJ3492508Medicaid
NJ555352Medicare PIN