Provider Demographics
NPI:1508160201
Name:OLD BRIDGE VISION INC
Entity Type:Organization
Organization Name:OLD BRIDGE VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-727-1811
Mailing Address - Street 1:1040 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1401
Mailing Address - Country:US
Mailing Address - Phone:732-727-1811
Mailing Address - Fax:732-727-6399
Practice Address - Street 1:1040 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1401
Practice Address - Country:US
Practice Address - Phone:732-727-1811
Practice Address - Fax:732-727-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ204162Medicare PIN