Provider Demographics
NPI:1962456509
Name:FOHOLDINGS, LLC
Entity Type:Organization
Organization Name:FOHOLDINGS, LLC
Other - Org Name:WITLIN CENTER FOR ADVANCED EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTENHUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-431-9333
Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-698-9300
Mailing Address - Fax:732-254-0786
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 15
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-698-9300
Practice Address - Fax:732-254-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57524Medicare UPIN