Provider Demographics
NPI:1972548824
Name:ADVANCED EYECARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED EYECARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-584-2020
Mailing Address - Street 1:410 ROUTE 10
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9658
Mailing Address - Country:US
Mailing Address - Phone:973-584-2020
Mailing Address - Fax:973-584-4992
Practice Address - Street 1:410 ROUTE 10
Practice Address - Street 2:SUITE 202
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9658
Practice Address - Country:US
Practice Address - Phone:973-584-2020
Practice Address - Fax:973-584-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA00511801152W00000X
NJOA00375200152W00000X
NJOA00588000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026339Medicare ID - Type UnspecifiedDR. SIEGEL
NJU26860Medicare UPIN
NJ521312Medicare ID - Type UnspecifiedDR. BROOKS
NJU19813Medicare UPIN