Provider Demographics
NPI:1356624563
Name:OLYMPUS EYECARE LLC
Entity type:Organization
Organization Name:OLYMPUS EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-218-4485
Mailing Address - Street 1:538 UNDERCLIFF AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1310
Mailing Address - Country:US
Mailing Address - Phone:201-218-4485
Mailing Address - Fax:
Practice Address - Street 1:3907 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4819
Practice Address - Country:US
Practice Address - Phone:201-865-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00124500152W00000X
NY6841152W00000X
NJ27OA00584700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty