Provider Demographics
NPI:1215772173
Name:ANTENA EYECARE LLC
Entity type:Organization
Organization Name:ANTENA EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-272-9700
Mailing Address - Street 1:2033 LEMOINE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5718
Mailing Address - Country:US
Mailing Address - Phone:201-272-9700
Mailing Address - Fax:
Practice Address - Street 1:2033 LEMOINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5718
Practice Address - Country:US
Practice Address - Phone:201-272-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier