Provider Demographics
NPI:1134215338
Name:THE SPRINGFIELD EYE SURGERY AND LASER CENTER
Entity type:Organization
Organization Name:THE SPRINGFIELD EYE SURGERY AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-789-8999
Mailing Address - Street 1:105 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1327
Mailing Address - Country:US
Mailing Address - Phone:908-789-8999
Mailing Address - Fax:908-789-8999
Practice Address - Street 1:105 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1327
Practice Address - Country:US
Practice Address - Phone:908-789-8999
Practice Address - Fax:908-789-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5137209Medicare ID - Type Unspecified
NJ305689Medicare ID - Type Unspecified