Provider Demographics
NPI:1003973595
Name:MOBILE VISION LLC
Entity type:Organization
Organization Name:MOBILE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GERSHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-431-9333
Mailing Address - Street 1:509 STILLWELLS CORNER ROAD
Mailing Address - Street 2:SUITE E5
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2965
Mailing Address - Country:US
Mailing Address - Phone:732-431-9333
Mailing Address - Fax:732-431-3312
Practice Address - Street 1:509 STILLWELLS CORNER ROAD
Practice Address - Street 2:SUITE E5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2965
Practice Address - Country:US
Practice Address - Phone:732-431-9333
Practice Address - Fax:732-431-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ005273152W00000X
NJ25MA07781000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty