Provider Demographics
NPI:1215159702
Name:MEYERIENZO EYECARE PA
Entity type:Organization
Organization Name:MEYERIENZO EYECARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-222-3937
Mailing Address - Street 1:123 RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:201-222-3937
Mailing Address - Fax:
Practice Address - Street 1:123 RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310
Practice Address - Country:US
Practice Address - Phone:201-222-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00470600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT-91461Medicare UPIN
NJ594468Medicare PIN