Provider Demographics
NPI:1336364355
Name:VISION CARE, P.A.
Entity Type:Organization
Organization Name:VISION CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-877-8550
Mailing Address - Street 1:1101 KINGS HWY N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1912
Mailing Address - Country:US
Mailing Address - Phone:856-779-0331
Mailing Address - Fax:609-877-5970
Practice Address - Street 1:1101 KINGS HWY N
Practice Address - Street 2:SUITE 301
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1912
Practice Address - Country:US
Practice Address - Phone:856-779-0331
Practice Address - Fax:609-877-5970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION CARE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA002621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#