Provider Demographics
NPI:1245315969
Name:BRIGANTINE EYE CARE CENTER
Entity type:Organization
Organization Name:BRIGANTINE EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-266-8000
Mailing Address - Street 1:4274 HARBOUR BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1362
Mailing Address - Country:US
Mailing Address - Phone:609-266-8000
Mailing Address - Fax:609-266-9555
Practice Address - Street 1:4274 HARBOUR BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1362
Practice Address - Country:US
Practice Address - Phone:609-266-8000
Practice Address - Fax:609-266-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB54894207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042383OtherRAILROAD MEDICARE
NJ032310OtherAMERIHEALTH PPO
NJ5491207Medicaid
NJ0443917000OtherAMERIHEALTH HMO
NJ=========OtherOXFORD
NJ=========OtherTRICARE
NJ=========OtherAMERIHEALTH
NJ=========OtherATLANTICARE ADMIN
NJ032310OtherAMERIHEALTH PPO
NJ0443917000OtherAMERIHEALTH HMO
NJ=========OtherAETNA
NJ=========OtherUNITED HEALTHCARE
NJ=========OtherAMERIHEALTH
NJ042383OtherRAILROAD MEDICARE