Provider Demographics
NPI:1669553087
Name:EYEXAM GROUP P A
Entity type:Organization
Organization Name:EYEXAM GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-262-7100
Mailing Address - Street 1:340 N RTE 17
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2906
Mailing Address - Country:US
Mailing Address - Phone:201-262-7100
Mailing Address - Fax:201-262-4318
Practice Address - Street 1:340 N RTE 17
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2906
Practice Address - Country:US
Practice Address - Phone:201-262-7100
Practice Address - Fax:201-262-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00386400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ457036Medicare PIN