Provider Demographics
NPI:1104256395
Name:PANCURAK EYE CENTER LLC
Entity type:Organization
Organization Name:PANCURAK EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-223-6555
Mailing Address - Street 1:436 COMMONS WAY BLDG D
Mailing Address - Street 2:ROUTE 37 WEST
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6428
Mailing Address - Country:US
Mailing Address - Phone:732-223-6555
Mailing Address - Fax:732-223-3228
Practice Address - Street 1:436 COMMONS WAY BLDG D
Practice Address - Street 2:ROUTE 37 WEST
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6428
Practice Address - Country:US
Practice Address - Phone:732-223-6555
Practice Address - Fax:732-223-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ331360Medicare PIN