Provider Demographics
NPI:1336215425
Name:EYE SITE EYE CARE CENTER PC
Entity Type:Organization
Organization Name:EYE SITE EYE CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-871-9666
Mailing Address - Street 1:42 CHALFORD LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3402
Mailing Address - Country:US
Mailing Address - Phone:609-871-9666
Mailing Address - Fax:609-871-9669
Practice Address - Street 1:42 CHALFORD LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3402
Practice Address - Country:US
Practice Address - Phone:609-871-9666
Practice Address - Fax:609-871-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00284300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7775806Medicaid
NJ7775806Medicaid
NJ035854Medicare PIN