Provider Demographics
NPI:1154373819
Name:EYE HEALTH GROUP OF SPRINGFIELD, LLC
Entity type:Organization
Organization Name:EYE HEALTH GROUP OF SPRINGFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:IULIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-505-0533
Mailing Address - Street 1:1278 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3324
Mailing Address - Country:US
Mailing Address - Phone:732-505-0533
Mailing Address - Fax:732-505-6572
Practice Address - Street 1:275 ROUTE 22
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3554
Practice Address - Country:US
Practice Address - Phone:973-376-8900
Practice Address - Fax:973-912-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102754Medicare PIN