Provider Demographics
NPI:1700180544
Name:ADVANCED EYE PROFESSIONALS
Entity Type:Organization
Organization Name:ADVANCED EYE PROFESSIONALS
Other - Org Name:BRIGHTON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENEIRAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-687-2448
Mailing Address - Street 1:225 GORDONS CORNER RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3356
Mailing Address - Country:US
Mailing Address - Phone:732-792-9800
Mailing Address - Fax:732-792-0600
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3356
Practice Address - Country:US
Practice Address - Phone:732-792-9800
Practice Address - Fax:732-792-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00567600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8358401Medicaid
NJ039686Medicare PIN
NJ8358401Medicaid