Provider Demographics
NPI:1932306024
Name:MT HOLLY EYE PHYSICIANS & SURGEONS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:MT HOLLY EYE PHYSICIANS & SURGEONS PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-983-1400
Mailing Address - Street 1:1613 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048
Mailing Address - Country:US
Mailing Address - Phone:609-267-5577
Mailing Address - Fax:609-267-5570
Practice Address - Street 1:1613 ROUTE 38
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048
Practice Address - Country:US
Practice Address - Phone:609-267-5577
Practice Address - Fax:609-267-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51463Medicare UPIN