Provider Demographics
NPI:1013336601
Name:EXCEPTIONAL EYE CARE GROUP OF SPRINGFIELD L.L.C.
Entity Type:Organization
Organization Name:EXCEPTIONAL EYE CARE GROUP OF SPRINGFIELD L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-489-8868
Mailing Address - Street 1:55-D ROUTE 22 EAST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-376-5555
Mailing Address - Fax:
Practice Address - Street 1:55-D ROUTE 22 EAST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-376-5555
Practice Address - Fax:201-489-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty