Provider Demographics
NPI:1801961313
Name:PRINCETON EYE GROUP PA
Entity type:Organization
Organization Name:PRINCETON EYE GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-9437
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-921-9437
Mailing Address - Fax:609-921-0277
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-921-9437
Practice Address - Fax:609-921-0277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON EYE GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45966261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311040Medicare PIN