Provider Demographics
NPI:1982840302
Name:EYE INSTITUTE NORTH, L.L.C.
Entity Type:Organization
Organization Name:EYE INSTITUTE NORTH, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-208-0400
Mailing Address - Street 1:5677 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9821
Mailing Address - Country:US
Mailing Address - Phone:973-208-0600
Mailing Address - Fax:973-208-0663
Practice Address - Street 1:5677 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9821
Practice Address - Country:US
Practice Address - Phone:973-208-0600
Practice Address - Fax:973-208-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02243700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty