Provider Demographics
NPI:1104902980
Name:PLAINFIELD EYE ASSOCIATES PA
Entity type:Organization
Organization Name:PLAINFIELD EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-561-7474
Mailing Address - Street 1:4919 STELTON ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1113
Mailing Address - Country:US
Mailing Address - Phone:908-561-7474
Mailing Address - Fax:908-561-2614
Practice Address - Street 1:4919 STELTON ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1113
Practice Address - Country:US
Practice Address - Phone:908-561-7474
Practice Address - Fax:908-561-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PL696771Medicare ID - Type Unspecified