Provider Demographics
NPI:1912925868
Name:MICHAEL L. MUND, M.D., F.A.C.S., P.A.
Entity Type:Organization
Organization Name:MICHAEL L. MUND, M.D., F.A.C.S., P.A.
Other - Org Name:EYE CARE CENTER OF NEW JERSEY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-546-6161
Mailing Address - Street 1:1187 MAIN AVE
Mailing Address - Street 2:STE. 1F
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2252
Mailing Address - Country:US
Mailing Address - Phone:973-546-6161
Mailing Address - Fax:973-546-1708
Practice Address - Street 1:1187 MAIN AVE
Practice Address - Street 2:STE. 1F
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:973-546-6161
Practice Address - Fax:973-546-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02610200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2906503Medicaid
NJ2906503Medicaid