Provider Demographics
NPI:1013461169
Name:PRINCETON EYE GROUP, PA
Entity Type:Organization
Organization Name:PRINCETON EYE GROUP, PA
Other - Org Name:THE OPTICAL SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-9437
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-921-9437
Mailing Address - Fax:609-921-0277
Practice Address - Street 1:900 EASTON AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1760
Practice Address - Country:US
Practice Address - Phone:732-565-1440
Practice Address - Fax:732-565-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1782332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ165695Medicare PIN