Provider Demographics
NPI:1063168227
Name:MODERN EYE CARE OF NJ
Entity type:Organization
Organization Name:MODERN EYE CARE OF NJ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKLINE
Authorized Official - Middle Name:ZAKY
Authorized Official - Last Name:SHAWKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-858-1646
Mailing Address - Street 1:2128 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2822
Mailing Address - Country:US
Mailing Address - Phone:732-858-1646
Mailing Address - Fax:
Practice Address - Street 1:2128 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2822
Practice Address - Country:US
Practice Address - Phone:732-858-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty