Provider Demographics
NPI:1134746985
Name:PRECISION EYECARE OF NJ LLC
Entity type:Organization
Organization Name:PRECISION EYECARE OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:862-686-6599
Mailing Address - Street 1:370 HIGHWAY 35 STE 202
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5922
Mailing Address - Country:US
Mailing Address - Phone:732-842-9177
Mailing Address - Fax:732-842-9370
Practice Address - Street 1:370 HIGHWAY 35 STE 202
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5922
Practice Address - Country:US
Practice Address - Phone:732-842-9177
Practice Address - Fax:732-842-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty