Provider Demographics
NPI:1205967973
Name:SOMERSET EYE CARE, LLC
Entity type:Organization
Organization Name:SOMERSET EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:IVOR
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-658-6765
Mailing Address - Street 1:2090 STATE ROUTE 27
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1142
Mailing Address - Country:US
Mailing Address - Phone:732-658-6765
Mailing Address - Fax:732-568-0041
Practice Address - Street 1:2090 STATE ROUTE 27
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1142
Practice Address - Country:US
Practice Address - Phone:732-658-6765
Practice Address - Fax:732-568-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5492152W00000X
NJOA5536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU67067Medicare UPIN
NJ017384PM8Medicare PIN
NJ045372Medicare PIN
NJU72045Medicare UPIN
NJ4158980001Medicare NSC
NJ901363PM8Medicare PIN
NJU72045Medicare UPIN
NJ901363PM8Medicare ID - Type UnspecifiedBETHANY FISHBEIN MEDICARE
NJ017384PM8Medicare PIN