Provider Demographics
NPI:1649526849
Name:BRUNSWICK VISION CARE LLC
Entity type:Organization
Organization Name:BRUNSWICK VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIEWAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-656-1515
Mailing Address - Street 1:333 FORSGATE DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-656-1515
Mailing Address - Fax:
Practice Address - Street 1:333 FORSGATE DR UNIT 6
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-656-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00638000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ243866Medicare PIN