Provider Demographics
NPI:1285918722
Name:HADDON FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:HADDON FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-547-1339
Mailing Address - Street 1:105 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1909
Mailing Address - Country:US
Mailing Address - Phone:856-547-1339
Mailing Address - Fax:856-546-8136
Practice Address - Street 1:105 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1909
Practice Address - Country:US
Practice Address - Phone:856-547-1339
Practice Address - Fax:856-546-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00558400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016725080004Medicaid
NJ7849303Medicaid
NJ7849303Medicaid
NJU65010Medicare UPIN