Provider Demographics
NPI:1841475274
Name:ADVANCED EYECARE OF MILLSTONE
Entity type:Organization
Organization Name:ADVANCED EYECARE OF MILLSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KINNARI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-259-2221
Mailing Address - Street 1:498 MONMOUTH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1219
Mailing Address - Country:US
Mailing Address - Phone:609-259-2221
Mailing Address - Fax:609-259-2291
Practice Address - Street 1:498 MONMOUTH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08510-1219
Practice Address - Country:US
Practice Address - Phone:609-259-2221
Practice Address - Fax:609-259-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00599700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100951Medicare UPIN
NJV09244Medicare UPIN