Provider Demographics
NPI:1801931589
Name:LACEY VISION CENTER INC
Entity type:Organization
Organization Name:LACEY VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-693-8808
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-0367
Mailing Address - Country:US
Mailing Address - Phone:609-693-8808
Mailing Address - Fax:609-242-1078
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2834
Practice Address - Country:US
Practice Address - Phone:609-693-8808
Practice Address - Fax:609-242-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521612Medicare PIN
NJ0635970001Medicare NSC