Provider Demographics
NPI:1780772046
Name:OUTLOOK EYECARE, P.C.
Entity type:Organization
Organization Name:OUTLOOK EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRABOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-409-2778
Mailing Address - Street 1:5 CENTRE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1564
Mailing Address - Country:US
Mailing Address - Phone:609-409-2778
Mailing Address - Fax:609-409-2718
Practice Address - Street 1:5 CENTRE DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-409-2778
Practice Address - Fax:609-409-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03961900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCK3685OtherRAILROAD MEDICARE
NJCK3685OtherRAILROAD MEDICARE
NJ038867Medicare ID - Type Unspecified
NJ=========OtherBILLING TAX ID
4111580003Medicare NSC