Provider Demographics
NPI:1457354037
Name:OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Entity Type:Organization
Organization Name:OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Other - Org Name:EYES FIRST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-200-4393
Mailing Address - Street 1:1147 HWY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2605
Mailing Address - Country:US
Mailing Address - Phone:732-671-7300
Mailing Address - Fax:732-706-1605
Practice Address - Street 1:1147 HWY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2605
Practice Address - Country:US
Practice Address - Phone:732-671-7300
Practice Address - Fax:732-706-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3175308Medicaid
NJ3175308Medicaid
NJ783588Medicare PIN