Provider Demographics
NPI:1104094622
Name:FAMILY EYE CARE
Entity type:Organization
Organization Name:FAMILY EYE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-679-2020
Mailing Address - Street 1:3111 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2690
Mailing Address - Country:US
Mailing Address - Phone:732-679-2020
Mailing Address - Fax:732-679-6980
Practice Address - Street 1:3111 ROUTE 9
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2690
Practice Address - Country:US
Practice Address - Phone:732-679-2020
Practice Address - Fax:732-679-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5021103Medicaid
NJ703284Medicare PIN
NJT81541Medicare UPIN
NJ5021103Medicaid