Provider Demographics
NPI:1194771634
Name:MOORESTOWN EYE ASSOCIATES
Entity type:Organization
Organization Name:MOORESTOWN EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-235-2620
Mailing Address - Street 1:301 N CHURCH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2498
Mailing Address - Country:US
Mailing Address - Phone:856-235-2620
Mailing Address - Fax:
Practice Address - Street 1:301 N CHURCH ST
Practice Address - Street 2:STE 201
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2498
Practice Address - Country:US
Practice Address - Phone:856-235-2620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
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
NJ0415179000OtherAMERIHEALTH ADMINISTRATOR
NJ960912OtherAMERIHEALTH PERSONAL CHOI
NJ0415179000OtherKEYSTONE
NJ0415179000OtherAMERIHEALTH HMO
NJ0415179000OtherKEYSTONE
NJ960912OtherAMERIHEALTH PERSONAL CHOI
NJ=========OtherHORIZONBCBSNJ
NJ=========OtherVISION SERVICE PLAN
NJ=========OtherVSP
NJ0415179000OtherAMERIHEALTH ADMINISTRATOR
NJ=========OtherTRICARE
NJ0415179000OtherAMERIHEALTH HMO
NJ=========OtherAETNA
NJ=========OtherCIGNA
NJ=========OtherINTERGROUP
NJ0415179000OtherAMERIHEALTH HMO
NJ0415179000OtherAMERIHEALTH ADMINISTRATOR