Provider Demographics
NPI:1154529329
Name:RETINAL AND OPHTHALMIC CONSULTANTS, PC
Entity type:Organization
Organization Name:RETINAL AND OPHTHALMIC CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-507-0020
Mailing Address - Street 1:2466 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8486
Mailing Address - Country:US
Mailing Address - Phone:856-507-0020
Mailing Address - Fax:856-507-0040
Practice Address - Street 1:2466 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8486
Practice Address - Country:US
Practice Address - Phone:856-507-0020
Practice Address - Fax:856-507-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7296908Medicaid
NJ672209Medicare PIN
NJ7296908Medicaid