Provider Demographics
NPI:1104969088
Name:EYEGLASS CITY CORP
Entity type:Organization
Organization Name:EYEGLASS CITY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIGIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-768-9583
Mailing Address - Street 1:41 CLEMENTON RD
Mailing Address - Street 2:STORE 328
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1300
Mailing Address - Country:US
Mailing Address - Phone:856-768-9583
Mailing Address - Fax:856-939-0602
Practice Address - Street 1:41 CLEMENTON RD
Practice Address - Street 2:STORE 328
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1300
Practice Address - Country:US
Practice Address - Phone:856-768-9583
Practice Address - Fax:856-939-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069973Medicaid