Provider Demographics
NPI:1801456967
Name:AG VISION CARE LLC
Entity type:Organization
Organization Name:AG VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASUYI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-810-5540
Mailing Address - Street 1:9 WAKEMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2114
Mailing Address - Country:US
Mailing Address - Phone:347-866-6331
Mailing Address - Fax:
Practice Address - Street 1:787 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3717
Practice Address - Country:US
Practice Address - Phone:973-810-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty