Provider Demographics
NPI:1982868204
Name:DR. PONG EYECARE LLC
Entity Type:Organization
Organization Name:DR. PONG EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIN-TSAI
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:PONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-817-8219
Mailing Address - Street 1:60 GATHERING HILL COURT
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950
Mailing Address - Country:US
Mailing Address - Phone:917-817-8219
Mailing Address - Fax:973-267-6806
Practice Address - Street 1:US RT. 80 AND MOUNT HOPE AVENUE
Practice Address - Street 2:JCPENNEY OPTICAL / ROCKAWAY TOWNSQUARE MALL
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866
Practice Address - Country:US
Practice Address - Phone:973-442-7580
Practice Address - Fax:973-361-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00612700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty